Thomas Dabreteau

Synchronous low grade endometrioid endometrial and ovarian cancer: Focus on therapeutic de-escalation proposed by the latest 2020 ESMO/ESTRO/ESP guidelines

Surgical treatment of vaginal and vulvar melanoma: a 18-year retrospective study

Vaginal and vulvar melanomas are rare and seems to have extremely poor prognosis, often diagnosed with locally advance stage, with difficulties to obtain free surgical margin. The aim of this study was to describe long term outcomes of vaginal and vulvar melanomas after surgical treatment. Retrospective observationnal cohort study between January 2002 and december 2020 at Gustave-Roussy Institute. A total of 57 patients were treated for vulvar and vaginal melanoma between january 2002 and december 2020. Among them 38.6 % (22/57) had surgery for vaginal (10/22) or vulvar melanoma (12/22). The main symptoms at diagnosis were vaginal bleeding for 40.9 % (n = 9/22), and vaginal mass for 36.4 % (n = 8/22) of the patients. Median tumor size was 15 mm (10-30). Free margins was obtained in 55.5 % of the cases (n = 12/20). Mutation (c-KIT, BRAF, NRAF) were found in 27 .3 % of the patients (6/22). Median progression free survival was 7.5 (5-11) months and overall survival 24 (12-41) months. Vaginal and vulvar melanoma have a poor prognosis. Extensive surgery with anterior or posterior pelvectomy shoud only be performed to obtained free margin with caution in well selected patient. Radiological lymph node should contraindicate primary surgical strategy. Neodjuvant immunotherapy could help to obtained free margin in patient with high risk of invaded margin, these patients should be included in randomized controlled clinical trials.

Fertility preservation in gynecologic oncology: evaluating knowledge, practices, and barriers among French healthcare providers

To assess the knowledge, practices, and referral patterns of health care professionals and fertility preservation specialists regarding fertility preservation in gynecologic oncology in France. In this cross sectional study, an electronic questionnaire was distributed between June 2023 and January 2024 to health care professionals in metropolitan and overseas territories. It included sections on demographics, fertility preservation practices, and technical knowledge, with tailored sections for physicians who are specialists and non-specialists in reproductive medicine. Sixty-four professionals participated (mean experience: 12 years); 65.6% (42/64) were gynecologic surgeons, and 18.8% (12/64) were specialists in reproductive medicine. Among non-specialists (52/64), 82.7% (43/52) routinely discussed fertility with patients of childbearing age, and 94.2% (49/52) had referred patients for fertility preservation. The mean knowledge score was 1.4/6. Only 23.1% (12/52) reported having written materials for patients, and 65.4% (34/52) indicated that no fertility specialist was present at multidisciplinary meetings. All reproductive medicine specialists (n = 12) reported access to oocyte and ovarian tissue cryopreservation, but 83.3% (10/12) believed patients were under-referred. They emphasized the need for systematic discussions of fertility preservation in multidisciplinary settings and highlighted risks associated with ovarian stimulation and tissue reimplantation. The upper age limit for oocyte cryopreservation was generally under 40 years. Pregnancy outcomes following fertility preservation were limited, primarily in cases of borderline ovarian tumors. Fertility preservation is recognized as a critical component of gynecologic oncology care, but significant gaps remain in knowledge, referrals, and integration into multidisciplinary care. Strengthening collaboration between oncology and fertility teams, standardizing care pathways, and enhancing education for health care providers are essential steps to improving access and outcomes for patients.