Marília Bertolazzi

Randomized trial of autologous ovarian graft to preserve ovarian function in young women undergoing pelvic radiotherapy for cervical cancer

To evaluate the short-term feasibility and efficacy of fresh autologous ovarian tissue grafting into the subcutaneous tissue for the prevention of hypoestrogenism in young women with cervical cancer undergoing pelvic radiotherapy. Single center, nonblinded, exploratory phase II randomized trial conducted at Instituto do Câncer do Estado de São Paulo, Brazil, from June 2022 to April 2025. Women aged ≤35 years with locally advanced cervical cancer (FIGO 2018 stages IB3-IVA), preserved ovarian function, and histologic subtypes of squamous cell carcinoma or usual adenocarcinoma, eligible for definitive pelvic radiotherapy. Participants were randomized 1:1 to an intervention group (n = 12) with underwent autologous fresh ovarian tissue grafting into the subcutaneous tissue prior to pelvic radiotherapy, or to a control group (n = 10), with did not undergo grafting. Hormonal ovarian function assessed by serum estradiol and follicle-stimulating hormone (FSH) levels. A total of 22 patients were enrolled, with three excluded from the intervention group due to clinical conditions. The median follow-up was 18.9 months. At six months, 85% of patients in the intervention group maintained hormonal profiles consistent with preserved ovarian function and were free of climacteric symptoms, whereas all controls exhibited profiles compatible with premature ovarian insufficiency. Baseline assessments confirmed normal ovarian function in all participants. Fresh autologous subcutaneous ovarian grafting was technically safe, feasible and effective in preventing hypoestrogenism and climacteric symptoms during short-term follow-up in young women undergoing pelvic radiotherapy for cervical cancer.

Analysis of Sentinel Lymph Node Adoption Compared to Systematic Lymphadenectomy in Staging Early Endometrial Cancer at a Tertiary Center: An Ambispective Study

ABSTRACTObjectiveThe purpose of this study was to assess the impact of changing endometrial carcinoma staging from systematic lymph node dissection to the sentinel lymph node approach.MethodsThis is an ambispective study including patients with endometrial carcinoma (EC) limited to the uterus (FIGO 2018 IA/IB). From December 2015 to October 2021, a group of patients underwent systematic staging with lymph node dissection (LND). From December 2021 to April 2024, another group of patients underwent surgical staging with the sentinel lymph node‐indocyanine green (SLN) algorithm and pathology ultrastaging analisys. The groups were matched (1 LND: 1 SLN) based on age, body mass index (BMI), tumor type, tumor size, and myometrial invasion. The primary endpoints were lymph node involvement, length of surgery, and complications. Complications were classified according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0.ResultsTwo hundred fifty‐seven patients were surgically treated during the study period (156 in the LND cohort, 101 in the SLN cohort). Propensity score matching revealed two equivalent groups containing 84 patients each. The rate of positive lymph nodes was similar between the LND group (3.6%) and the SLN group (8.3%) (OR: 2.46, 95% CI: 0.61–9.84; p = 0.205). The length of surgery was significantly lower in the SLN group (152.2 ± 51.9 min) compared to the LND group (304 ± 77.8 min) (p < 0.001). Intraoperative blood loss greater than 100 mL was significantly lower in the SLN group (9.5%) compared to the LND group (29.8%) (p < 0.001). CTCAE grades requiring intervention (grades 3, 4, and 5) were higher in the LND group (14.3%) compared to the SLN group (4.8%) (p = 0.049).ConclusionThe transition from LND to SLN approach was similar compared to systematic lymphadenectomy, allowing the reduction of surgical length, blood loss and severity of complications without compromising surgical complications and lymph node positivity.