OBJECTIVE: The lack of training is a significant barrier to practicing brachytherapy (BT). Tata Memorial Centre, alongside international BT experts and BrachyAcademy, developed a hybrid gynecological BT training module. This study outlines the preparation, organization, and execution of the 2022-2023 Mumbai training, evaluates its effectiveness, and highlights areas for improvement.
METHODS: Participants were radiation oncologists (RO) and medical physicists (MP) with experience in gynecological BT aiming to transition to image-guided brachytherapy (IGBT). The training covered cervical, endometrial, vaginal, vulvar, periurethral cancers, and pelvic reirradiation. The hybrid course included online pre and postcourse homework assignments, a live workshop with hands-on training, a 6-month online follow-up, and a 12-month opportunity to share the transition experience.
RESULTS: The December 2022 Mumbai live workshop spanned 2.5 days, attracting 39 participants from 8 countries (Asia, Africa, Australia/Oceania). Feedback rated the course 9/10, with 78% fully meeting expectations. Forty-four percent suggested extending hands-on training. At the 6-month follow-up, response rates were low (33% RO, 11% MP). Among responding RO, 70% reported practice changes after attending the course, 40% implemented IGBT concepts in clinical practice, and 50% increased confidence in image-guided procedures. Overall, 45% of respondent sites could strengthen their intracavitary/interstitial program, while others faced limitations due to lack of access to advanced BT applicators.
CONCLUSIONS: The hybrid gynecological BT training concept was successfully executed. Areas for improvement include extending hands-on training and enhancing participant engagement postcourse. Structured steps beyond training may be needed to improve the utilization of advanced brachytherapy for gynecological cancers.

Multi-modal therapies for gynecological cancers management may determine a wide range of side effects which depend on therapy-related factors and patient characteristics and comorbidities. Curative or adjuvant pelvic radiotherapy is linked with acute and late toxicity due to irradiation of organs at risk, as small and large bowel, rectum, bladder, pelvic bone, vagina and bone marrow. Successful toxicity management varies with its severity, Radiation Centre practice and experience and skills of radiation oncologists. This position paper was designed by the Italian Association of Radiation and Clinical Oncology Gynecology Study Group to provide radiation oncologists with evidence-based strategies to prevent and manage acute and late toxicities and follow-up recommendations for gynecological cancer patients submitted radiotherapy. Six workgroups of radiation oncologists with over 5 years of experience in gynecologic cancers were setup to investigate radiotherapy-related toxicities. For each topic, PubMed database was searched for relevant English language papers from January 2005 to December 2022. Titles and abstracts of results were checked to verify suitability for the document. Reference lists of selected studies and review papers were added if pertinent. Data on incidence, etiopathogenesis, prevention, treatment and follow-up of acute and late side effects for each organ at risk are presented and discussed.

Gynecological cancers, including ovarian, cervical, endometrial, and vulvar cancers, present significant challenges in diagnosis and treatment globally. The tumor microenvironment (TME) plays a pivotal role in cancer progression and therapy response, necessitating a deeper understanding of its composition and dynamics. This review offers a comprehensive overview of the gynecological cancer tumor microenvironment, emphasizing its cellular complexity and therapeutic potential. The diverse cellular components of the TME, including cancer cells, immune cells, stromal cells, and extracellular matrix elements, are explored, elucidating their interplay in shaping tumor behavior and treatment outcomes. Across various stages of cancer progression, the TME exerts profound effects on tumor heterogeneity, immune modulation, angiogenesis, and metabolic reprogramming. The urgency for novel therapeutic strategies is underscored by understanding immune evasion mechanisms within the TME. Emerging approaches such as immunotherapy, stromal-targeting therapies, anti-angiogenic agents, and metabolic inhibitors are discussed, offering promising avenues for improving patient outcomes. Interdisciplinary collaborations and translational research are emphasized, aiming to advance precision oncology and enhance therapeutic efficacy in gynecological cancers.

OBJECTIVE: To determine if nutritional status effects response to immunotherapy in women with gynecologic malignancies.
METHODS: A retrospective chart review was conducted on gynecologic cancer patients who received immunotherapy at a single institution between 2015 and 2022. Immunotherapy included checkpoint inhibitors and tumor vaccines. The prognostic nutritional index (PNI) was calculated from serum albumin levels and total lymphocyte count. PNI values were determined at the beginning of treatment for each patient and assessed for their association with immunotherapy response. Disease control response (DCR) as an outcome of immunotherapy was defined as complete response, partial response, or stable disease.
RESULTS: One hundred and ninety-eight patients received immunotherapy (IT) between 2015 and 2022. The gynecological cancers treated were uterine (38%), cervix (32%), ovarian (25%), and vulvar or vaginal (4%) cancers. The mean PNI for responders was higher than the non-responder group (p < 0.05). The AUC value for PNI as a predictor of response was 49. A PNI value of 49 was 43% sensitive and 85% specific for predicting a DCR. In Cox proportional hazards analysis, after adjusting for ECOG score and the number of prior chemotherapy lines, severe malnutrition was associated with progression-free survival (PFS) (HR = 1.85, p = 0.08) and overall survival (OS) (HR = 3.82, p < 0.001). Patients with PNI < 49 were at a higher risk of IT failure (HR = 2.24, p = 0.0001) and subsequent death (HR = 2.84, p = 9 × 10-5).
CONCLUSIONS: PNI can be a prognostic marker to predict response rates of patients with gynecologic cancers treated with immunotherapy. Additional studies needed to understand the mechanistic role of malnutrition in immunotherapy response.

Gynecological cancers are prevalent malignancies among females, and surgical intervention is the primary therapeutic approach offering the possibility of a definitive cure. Recent research has highlighted the susceptibility of gynecological cancer patients to experiencing anxiety symptoms during the perioperative and postoperative phases, with this psychological condition being linked to suboptimal recovery following surgery. Nevertheless, certain interventions have shown promise in mitigating perioperative and postoperative anxiety in gynecological cancer patients. In this study, we conducted a comprehensive review to collect the existing evidence on this subject. Through a systematic search across six common databases, we screened and included 28 pertinent studies. The current review emphasizes the elevated occurrence of perioperative and postoperative anxiety among patients with gynecological cancers (i.e., uterine, cervical, ovarian, endometrial, and vulval cancers). Specific nursing interventions (i.e., crisis intervention nursing, multidisciplinary collaborative continuous nursing, psychological nursing, comprehensive psychological nursing, reminiscence therapy involved care, cognitive behavioral stress management, hospital-family integrated continuation nursing, high-quality nursing care, relaxation-focused nursing program, and relaxation/counseling intervention) and psychotropic medications may serve as dependable approaches to mitigate perioperative and postoperative anxiety. This study represents a novel contribution to the literature by providing a characterization of perioperative and postoperative anxiety in the context of gynecological oncology. The findings underscore the significance of addressing perioperative and postoperative anxiety as a critical clinical concern for individuals with gynecological cancers, emphasizing the need for further research to develop effective interventions.

BACKGROUND: Previous studies have highlighted patients with chronic conditions seek for medical knowledge and therapeutics on their own. So far, no data exist on the health literacy of patients with gynecological conditions and especially those suffering from endometriosis, whose symptoms\' have a major impact on their daily lives.
METHODS: The objective was to evaluate the health literacy of patients consulting in a referral expert center for the management of endometriosis and gynecological cancers. The secondary objective was to compare the health literacy of patients with endometriosis to patients without. We conducted an observational, prospective, monocentric study in the gynecological department of Tenon Hospital (Paris, France) between July 6, 2022 to January 3, 2023. All patients fulfilled the validated French version of HLS-EU-Q16 questionnaire.
RESULTS: One hundred and ten patients were included. The two following questions were identified as the most difficult among patients with endometriosis: \"Find information about treatments for their disease\" and \"know when it would be helpful to have another doctor\'s opinion\". Compared to patients consulting for other conditions, it was more difficult for patients with endometriosis to respectively \"find information about treatments for diseases\" and \"use information given by the doctor to take decisions about the illness\" (p = 0.003). Compared to patients consulting for cancer, it was more difficult for patient with endometriosis to \"find information about treatments for diseases\" (p = 0.02).
CONCLUSIONS: Progresses in the capacity of the health care to better inform the patients would be highly beneficial, especially for those suffering from endometriosis.

Gynecological cancers constitute an important global health problem with increasing incidence and prevalence. The aim of this study was to explain gynecologic cancer knowledge, attitudes, and cultural beliefs of Afghan refugee women living in Türkiye. This research was carried out as a descriptive phenomenological design for qualitative research. The study was conducted at the Refugee Support Center Association in Eskişehir, Türkiye, and data were collected between January and April 2023, guided by a semi-structured interview guide. Nineteen Afghan refugee women were interviewed. A purposive sampling method was used to recruit participants. Content analysis method was used for data analysis. Four overarching themes that described Afghan women\'s gynecologic cancer knowledge, attitudes, and cultural beliefs were identified: (a) limited awareness and knowledge of gynecological cancer among women, (b) women\'s attitudes toward gynecological cancers, (c) women\'s cultural beliefs regarding gynecological cancer, and (d) healthcare system factors. In line with the main themes, subthemes were created for each main theme. Afghan refugee women, who were in the double risk group as both women and refugees, had insufficient knowledge of gynecological cancers, and their cultural beliefs and attitudes played an essential role in their access to gynecological cancer-related preventive healthcare services. It is recommended that training be planned to increase the awareness and knowledge of Afghan women on gynecological cancers, considering their cultural characteristics.

Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse reaction to many first- and second-line chemotherapy medications that can be debilitating, severe, and often dose-limiting. Treatment options for CIPN are limited. We report a case of a 52-year-old female patient with Stage II ovarian cancer who was hospitalised in the chemotherapy ward for a second round of chemotherapy. We describe the effectiveness of closed kinetic chain (CKC) exercises for the management of CIPN symptoms. The patient was advised to take neurophysiotherapy. The patient complained of pain, tingling in both feet, weakness in the lower limbs, and trouble keeping her balance while walking. Thus, three days after the start of the chemotherapy drugs, physical therapy rehabilitation was started. The patient stated total pain reduction and a noticeable improvement in tingling and numbness in both lower extremities following four weeks of physical therapy. Even though CIPN usually disappears gradually over time, it can persist for an extended period. It seems doubtful that this was a spontaneous resolve, given the regularity of her symptoms before starting physiotherapy sessions and their quick recovery with treatment. Further investigation is required to comprehend the role that physiotherapy and non-pharmacologic interventions play in ameliorating CIPN symptoms and to ascertain if improvements in CIPN symptoms are associated with an increase in blood flow directly or indirectly.

BACKGROUND: Observational studies have shown that cholelithiasis and cholecystectomy are associated with the risk of breast cancer (BC) and gynecological cancers, but whether these relationships are causal has not been established and remains controversial.
METHODS: Our study began with a meta-analysis that synthesized data from prior observational studies to examine the association between cholelithiasis, cholecystectomy, and the risk of BC and gynecological cancers. Subsequently, a two-sample Mendelian randomization (MR) analysis was conducted utilizing genetic variant data to investigate the potential causal relationship between cholelithiasis, cholecystectomy, and the aforementioned cancers.
RESULTS: The results of the meta-analysis demonstrated a significant association between cholecystectomy and the risk of BC (risk ratio [RR] = 1.04, 95% confidence interval [CI]: 1.01-1.06, p = 0.002) and endometrial cancer (EC) (RR = 1.26, 95% CI: 1.02-1.56, p = 0.031). Conversely, no significant association was observed between cholelithiasis and the risk of BC, EC, and ovarian cancer. The MR analysis revealed no discernible causal connection between cholelithiasis and overall BC (p = 0.053), as well as BC subtypes (including estrogen receptor-positive/negative). Similarly, there was no causal effect of cholecystectomy on BC risk (p = 0.399) and its subtypes. Furthermore, no causal associations were identified between cholelithiasis, cholecystectomy, and the risk of gynecological cancers (ovarian, endometrial, and cervical cancer [CC]) (all p > 0.05).
CONCLUSIONS: This study does not support a causal link between cholelithiasis and cholecystectomy and an increased risk of female cancers such as breast, endometrial, ovarian, and CC.

The main objective of this study was to review and perform a meta-analysis of current literature on the use of indocyanine green for sentinel lymph node detection in pelvic gynecologic cancer. We included all studies focusing on indications and procedures associated with the use of ICG in gynecologic surgery and available on the Medline and Pubmed database. For the meta-analysis, random effect models were used for estimation of the 95 % detection rate and 95 % confidence interval, and stratified analyses by cancer type, concentration and localization of injection were performed. A total of 147 articles were included, of which 91 were studied in a meta-analysis. Results concerning detection rate by indocyanine green injection site were found to be 95.1 % and 97.3 % respectively for intracervical injection in 2 or 4 quadrants, and 77.0 % and 94.8 % for hysteroscopic and intradermal injection respectively. Results concerning detection rate by cancer type were 95.8 %, 95.2 %, 94.7 % and 95.7 % respectively for cervical, endometrial, vulvar and endometrial/cervical cancers. Finally, the results concerning detection rate by indocyanine green concentration were 91.2 %, 95.7 %, 96.7 % and 97.7 % for concentrations of <1.25 mg/ml, 1.25 mg/ml, 2.5 mg/ml and 5 mg/ml respectively. In conclusion, indocyanine green is shown to allow highlighting of sentinel lymph nodes with good reliability with an overall indocyanine green detection rate of 95.5 %. Our literature review revealed that indocyanine green feasibility has also been demonstrated in several surgical contexts, notably for reconstructive surgery and detection of endometriosis.