Maja Pakiz

ESTRO/ESGO/SIOPe Guidelines for the management of patients with vaginal cancer

Primary vaginal malignancies are rare, comprising only 2% of all female genital tract malignancies in adults and 4.5% in children. As part of its mission to improve the quality of care for women with gynecological cancers across Europe, the European Society of Gynaecological Oncology (ESGO) jointly with the European Society for Radiotherapy & Oncology (ESTRO) and the European Society of Pediatric Oncology (SIOPe) developed evidence-based guidelines in order to improve the management of patients with vaginal cancer within a multidisciplinary setting.ESTRO/ESGO/SIOPe nominated practicing clinicians who are involved in the management of vaginal cancer patients and have demonstrated leadership through their expertise in clinical care and research, their national and international engagement and profile as well as dedication to the topics addressed to serve on the expert panel (13 experts across Europe comprising the international development group). To ensure that the statements were evidence based, the current literature was reviewed and critically appraised.In the case of absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the international development group. Prior to publication, the guidelines were reviewed by 112 independent international practitionners in cancer care delivery and patient representatives and their comments and input were incorporated and addressed accordingly.These guidelines cover comprehensively the diagnostic pathways as well as the surgical, radiotherapeutical and systemic management and follow-up of adult patients (including those with rare histological subtypes) and pediatric patients (vaginal rhabdomyosarcoma and germ cell tumours) with vaginal tumours.

The European Society of Gynaecological Oncology position statement: promoting inclusive surgical ergonomics in gynecological oncology

The European Society of Gynaecological Oncology (ESGO) recognizes that poorly designed instruments and operating room environments contribute to musculoskeletal injuries, fatigue, and burnout, disproportionately affecting female and smaller-stature surgeons. Ergonomic equity is central to ensuring surgical precision, team well-being, and optimal patient outcomes. ESGO calls for close collaboration between surgeons, industry partners, and hospital systems to re-design surgical instruments and equipment. Adaptable grip sizes, adjustable weight distribution, and inclusive workstation designs must be prioritized to accommodate diverse anthropometric needs and improve comfort, dexterity, and performance. INCLUSIVE OPERATING ROOM DESIGN AND STANDARDIZED SUPPORT MEASURES: Operating rooms should be designed to support diverse surgical teams, including surgeons of different statures, hand sizes, and physical capacities. ESGO recommends adjustable tables, consoles, lighting, and pedals, alongside consistent policies for accommodating pregnant and postpartum surgeons through measures such as flexible seating and scheduled breaks. ESGO advocates for the integration of ergonomic training into surgical education and continuing professional development. Standardized guidelines, intraoperative microbreaks, and mentorship initiatives are key strategies to reduce injury risks, enhance surgical longevity, and foster equality, diversity, and inclusion within gynecological oncology.

Access to molecular classification in endometrial cancer recommended by ESGO–ESTRO–ESP guidelines: multi-national survey in Eastern Europe

Advances in tumor biology have transformed endometrial cancer management. Since 2021, ESGO-ESTRO-ESP (European Society of Gynaecological Oncology-European Society for Radiotherapy and Oncology-European Society of Pathology) guidelines have incorporated molecular classification, which is essential in the 2025 update. Its implementation in Eastern Europe remains unclear. This study evaluated the availability, reimbursement, and integration of molecular classification at national and institutional levels. A 2-phase cross-sectional online survey was conducted from December 2024 to September 2025. National coordinators from 17 European Society of Gynaecological Oncology-affiliated countries reported on access, reimbursement, and guidelines. A second survey targeted 67 treatment centers to assess institutional practices. Full molecular profiling (p53-abnormal, POLE-ultra-mutated, mismatch repair-deficient) was available in 29.4% of countries, with partial access in 70.6%. Lack of reimbursement and accredited laboratories were the main barriers. At least 1 test was publicly funded in 58.8% of countries: p53 and mismatch repair-deficient immunohistochemistry in 70.0% and POLE-ultra-mutated next-generation sequencing in 29.4%. National guidelines existed in over half of the countries, but few included molecular classification. At the institutional level, testing was routine in 41.0% of centers, selective in 27.9%, and unavailable in 31.1%. Overall, 55.8% reported access via local or external laboratories. Comprehensive classification was significantly more available in settings with national/public reimbursement (79.2% vs 18.9%, p < .0001). POLE-ultra-mutated testing was more accessible in private than public hospitals (42.9% vs 33.3%, p = .006), while p53 immunohistochemistry was more common in high-volume centers (97.5% vs 76.2%, p = .01). Access to molecular classification in Eastern Europe remains limited because of insufficient reimbursement and laboratory resources. Addressing these disparities is essential to support equitable treatment and improve outcomes.