TREATMENT OF SECONDARY LOWER LIMB LYMPHEDEMA AFTER GYNECOLOGIC CANCER WITH COMPLEX DECONGESTIVE THERAPY

Secondary lower extremity lymphedema is a common complication of treatment for gynecological cancers. Conservative therapy plays an important role in the treatment of patients with secondary lower extremity lymphedema; in particular, complex decongestive therapy (CDT) has been recognized as an effective nonoperative technique for these patients. But CDT therapy for secondary lower extremity lymphedema remains a problem in China because this technique and its effectiveness have not achieved widespread use and popularity. Our goal was to assess effects of CDT in patients with secondary lower limb lymphedema after treatment for gynecological cancers. The retrospective study consisted of 60 patients who were treated with 20 sessions of CDT. Assessments included objective changes in limb circumference, degree of LE, imaging features, and incidence of erysipelas before and after CDT treatment. We found that CDT can effectively improve lymph stasis and promote backflow, and decrease circumference, interstitial fluid content, and incidence of erysipelas of lymphedematous lower limb. Our results demonstrate that CDT is an effective treatment method for patients with secondary lower limb lymphedema following treatment for gynecologic cancers. This technique should be more widely utilized and popularized in China to improve the quality of life of millions of patients with secondary lower limb lymphedema.

Global burden of gynecological cancers

Gynecological cancers include malignant tumours arising from reproductive organs in women including ovaries, uterus, vagina vulva, and cervix. Cervical cancer is reported to be the most common cancer while the vagina is reported to have the lowest incidence all around the world. According to the World Health Organization report Asia has the highest rate of gynecological cancers followed by Africa, Europe, Latin America, North America, and the lowest rate is observed in Oceania. The rate was predicted to rise in the upcoming years. Thus appropriate strategies are needed to be adopted to control disease outcomes and adopt preventive strategies.

Building a Personalized Medicine Infrastructure for Gynecological Oncology Patients in a High-Volume Hospital

Gynecological cancers require complex intervention since patients have specific needs to be addressed. Centralization to high-volume centers improves the oncological outcomes of patients with gynecological cancers. Research in gynecological oncology is increasing thanks to modern technologies, from the comprehensive molecular characterization of tumors and individual pathophenotypes. Ongoing studies are focusing on personalizing therapies by integrating information across genomics, proteomics, and metabolomics with the genetic makeup and immune system of the patient. Hence, several challenges must be faced to provide holistic benefit to the patient. Personalized approaches should also recognize the unmet needs of each patient to successfully deliver the promise of personalized care, in a multidisciplinary effort. This may provide the greatest opportunity to improve patients’ outcomes. Starting from a narrative review on gynecological oncology patients’ needs, this article focuses on the experience of building a research and care infrastructure for personalized patient management.

Novel Therapeutic Strategies for Refractory Ovarian Cancers: Clear Cell and Mucinous Carcinomas

Ovarian cancer has the worst prognosis among gynecological cancers. In particular, clear cell and mucinous carcinomas are less sensitive to chemotherapy. The establishment of new therapies is necessary to improve the treatment outcomes for these carcinomas. In previous clinical studies, chemotherapy with cytotoxic anticancer drugs has failed to demonstrate better treatment outcomes than paclitaxel + carboplatin therapy. In recent years, attention has been focused on treatment with molecular target drugs and immune checkpoint inhibitors that target newly identified biomarkers. The issues that need to be addressed include the most appropriate combination of therapies, identifying patients who may benefit from each therapy, and how results should be incorporated into the standard of care for ovarian clear cell and mucinous carcinomas. In this article, we have reviewed the most promising therapies for ovarian clear cell and mucinous carcinomas, which are regarded as intractable, with an emphasis on therapies currently being investigated in clinical studies.

Modeling and analyzing predictive monthly survival in females diagnosed with gynecological cancers

Cancer ranks as a leading cause of death worldwide; an estimated 1.7 million new diagnoses were reported in 2021. Ovarian cancer, the most lethal of gynecological malignancies, has no effective screening with over 70% of patients being diagnosed in an advanced stage. The aim of this study was to determine the most statistically significant contributing factors through a multivariate regression into the severity of female gynecological cancers. Data from the surveillance, epidemiology, and end results program (SEER) cancer database were utilized in this study. Several attempted multivariate linear regressions were implemented with further reduced models; however, a linear model could not be properly fit to the data. Because of unmet assumptions, a nonparametric moving, local regression, locally estimated scatterplot smoothing (LOESS), was performed. After smoothing factors were included to reduced-models, residual information was minimized although few conclusions can be drawn from the resulting statistics. These issues were prevalent mainly because of the massive variability in the data and inherent lack of linearity. This can be a significant issue with clinical data that does not dive deeper into cancer-dependent factors including genetic expression and cell surface receptor overexpression. General patient demographic data and diagnostic information alone does not provide enough detail to make a definite conclusion or prediction on patient survivability. Increased attention to the acquisition of tumor tissue for genomic and proteomic analysis in addition to next-generation sequencing methods can lead to significant improvements in prognostic predictions.