Junzo P. Chino

Recent advances in gynecologic radiation oncology

AbstractSignificant advances have been made in the treatment of patients with gynecologic malignancies in the past few years. Integration of molecular testing in endometrial cancer now allows for more accurate risk stratification and personalized treatment recommendations for patients, with PORTEC‐4a investigating outcomes after treatment de‐escalation based on molecular subgroup. In several clinical trials, mismatch repair‐deficiency (MMR‐d) status has been proven to be a strong predictor for response to immunotherapy in the advanced/metastatic setting, and the role of immunotherapy in early‐stage endometrial cancer is now being investigated. For patients with locally advanced cervical cancer, results from INTERLACE demonstrate that induction chemotherapy is now a viable treatment option, and KEYNOTE A‐18 shows promise for the addition of concurrent and maintenance pembrolizumab to chemoradiation. Meanwhile, EMBRACE 1 and 2 have demonstrated the benefits of high‐quality image guided brachytherapy, providing patients with locally advanced cervical cancer excellent control with improved toxicity. For patients with vulvar cancer, GOG279 demonstrated that addition of multi‐agent chemotherapy with intensity modulated radiation therapy resulted in high rates of complete pathologic response, and GROINS‐V III is currently investigating the role of chemotherapy and nodal radiation for patients with macrometastases on sentinel lymph node biopsy. This work summarizes the findings of recent landmark trials in endometrial, cervical, and vulvar cancer and their implications for the radiation oncologist.

The American Brachytherapy Society (ABS) consensus guidance for hybrid intracavitary interstitial brachytherapy for locally advanced cervical cancer

The purpose of this consensus statement from the American Brachytherapy Society (ABS) is to summarize important considerations for adding interstitial needles to intracavitary implants for cervix cancer brachytherapy. A panel of experts in Gynecologic Brachytherapy, including both physicians and physicists completed surveys and met virtually on multiple occasions to discuss and define current practices and approaches in order to summarize these for the ABS community. This document was drafted, reviewed and approved by the full panel and the ABS Board of Directors. Hybrid brachytherapy is increasingly being utilized in cervix brachytherapy. In incorporating supplementary interstitial needles there are numerous key considerations including resources for an emergency, planning considerations, applicator selection, and pre-, intra- and postprocedural imaging. Additionally, approaches to challenging cases that would often benefit from a hybrid approach are discussed. While hybrid brachytherapy offers dosimetric advantages for cervix brachytherapy, it increases procedure complexity. Being aware of the necessary resources and defining considerations can help mitigate some of the challenges and improve procedural success.

Reports From Four International Clinical Trials for Cancers of the Cervix, Uterus and Vulva, and a New Guideline for Cervical Cancer

Improving Radiation Therapy for Cervical Cancer