Immunotherapy is becoming increasingly important in the management of urological, gynecological, and gastrointestinal cancers. Immune checkpoint inhibitor-based combinations have become a standard of care for patients with metastatic renal and liver cancers, as well as for many patients with bladder, cervical, gastric, and esophageal cancers, based on various biomarkers. Some tumor types are less responsive to immunotherapy, such as prostate and colon cancer. In these tumors, however, a subgroup of patients with a microsatellite-instability-high/DNA-mismatch repair deficient molecular phenotype significantly benefits from immunotherapy. Molecular characterization is therefore essential to identify patients who may benefit from these treatments. One of the major challenges is the search for new predictive biomarkers and novel combinations or strategies to further improve patient outcome.

Brachytherapy (BT), a type of focal cancer radiation therapy, delivers a highly focused dose of radiation to localized tumors, sparing surrounding normal tissue. Brachytherapy has been used to treat gynecologic malignancies, particularly cervical cancer, for over 100 years. From the first gynecologic brachytherapy treatments in the early 20th century to the modern era, significant transformations have taken place, largely due to advances in technology. The development of high-dose-rate sources, remote afterloaders, new applicators, and three-dimensional image guidance has increased tumor dose and, consequently, local control and survival, reinforcing brachytherapy\'s role as an integral component of gynecologic cancer treatment. Current research efforts involving biomarker research, integration of new imaging modalities, radiosensitizing therapies are aimed at further personalizing the dose delivered in BT to further improve local control and reduce treatment\'s related toxicities.

The evolution of knowledge in gynecologic oncology is leading to surgical de-escalation in several areas, particularly in lymph node staging. Sentinel lymph node biopsy that was initially used in low and intermediate risk endometrial cancer, has now been extended to high-intermediate and high-risk endometrial cancer. Sentinel lymph node biopsy plays also an important role in the nodal staging of early-stage cervical cancer. The radicality of hysterectomies in patients with early cervical cancer is under debate. Similarly, surgical staging with para-aortic lymphadenectomy in locally advanced cervical cancer should be performed only for few cases. Systematic pelvic and para-aortic lymphadenectomy in patients with advanced ovarian cancers is not recommended anymore.

Over the past years, planet oncology has kept changing and moving forward. Recent results of important clinical trials are challenging our daily practices. With modesty, the Editorial Board of BulletinduCancer has selected some clinical trials they consider as \"must-know about\" even if they go beyond our medical fields.

Vulvar cancer is a rare disease, which represents 4% of gynecological tumors with an incidence of 0.5 to 1.5 per 100,000 women per year in France. Vulvar cancers are induced in 30 to 69% of cases by the presence of papillomavirus (HPV), in particular HPV 16 and 18, and can also occur in an inflammatory context. The diagnosis is made by histological examination of a vulvar biopsy. The histological subtype is a squamous cell carcinoma in 90% of cases. The 5-year survival of patients with vulvar cancer ranges from 86% for localized stages (FIGO I and II) to 57% for advanced stages (FIGO III and IVA), and 17% in case of metastatic disease (FIGO IVB). The treatment of vulvar cancer is mainly surgical, but radiotherapy and chemotherapy have become more important in recent years. Management has evolved into a personalized multidisciplinary approach, where each therapeutic decision must be discussed in a multidisciplinary consultation meeting. Surgical excision with tumor- free margins is central in the management of early stages. The indication for radiotherapy and brachytherapy should be discussed in the event that the excisional margins are positive in early stages. Radiotherapy is indicated in cases of lymph node involvement or in a neoadjuvant situation if the tumor is not immediately resectable. In this situation, it can be associated with chemotherapy. Chemotherapy alone is the treatment of diseases that are metastatic at the time of diagnosis.

Intensity-modulated radiation therapy reduces the dose to organs at risk in patients treated for gynecological malignancies. Given the steep dose gradients around the planning target volume, internal movement of organs during treatment may cause a planning target volume underdosage and organs at risk overdosage in case of systematic error. It is therefore important to take into account the movement of the pelvic organs and to investigate potential solutions provided by image-guided radiotherapy. A review of the literature was carried out using the following databases: Medline, Embase, Cochrane Library, Web of Science, Cinahl and Pubmed. Appropriate search strategies for each database were applied based upon the following terms \"uterine neoplasms, image-guided radiotherapy, adaptive radiotherapy, organ motion and target volume\". These studies show that uterine motion is mainly influenced by bladder filling and by cervix and vaginal vault motion due to rectal filling. Population-based clinical target volume-planning target volume margins are large resulting in unnecessary organs at risk inclusion within the planning target volume, reducing the benefits of intensity-modulated radiotherapy. As pelvic organ motion seems to be patient specific, individualised planning target volume margins and adaptive radiotherapy strategies could allow adequate coverage of the planning target volume and increase organs at risk savings. In this study, we review the different techniques of image-guided radiotherapy and the perspective of adaptive radiotherapy.

The demonstration of frequent defects in the DNA damage response in high grade ovarian cancer has paved the way for a new therapeutic approach aimed at exploiting this unique vulnerability. The efficacy of poly (ADP) ribose polymerase inhibitors (PARPi) in patients with homologous recombination (HR) DNA repair deficient ovarian cancer (OC) resulting from a BRCA1/2 mutation has provided the proof of concept for synthetic lethality. Thus, olaparib is now approved by the EMA as maintenance therapy after response to a platinum regimen for patients with recurrent, platinum-sensitive, high-grade serous, BRCA1/2-mutated ovarian cancer. Furthermore, several recent trials in OC have demonstrated that the benefit of PARPi may not be limited to patients with BRCA mutations. These data, combined with genomic studies suggesting that a significant proportion of OC may harbor somatic and germline alterations in other HR genes open huge perspectives for exploiting DNA repair as a therapeutic strategy. The current priorities are to (i) determine whether new biomarkers of homologous recombination deficiency may identify the BRCA wild-type subset likely to derive benefit from PARPi; (ii) to determine whether the efficacy of PARPi can be improved by combinatorial strategies (with chemotherapy, radiotherapy, immunotherapy, anti-angiogenesis or DNA repair inhibitors) and (iii) to develop new approaches exploiting DNA repair deficiencies in ovarian and other gynecological tumors.

OBJECTIVE: Conflicting results concerning the toxicity of radiotherapy in the setting of rheumatoid arthritis were reported in literature. This work describes the toxicity profiles of patients with rheumatoid arthritis undergoing pelvic radiotherapy for gynecologic malignancies at our institution.
METHODS: Charts of patients with rheumatoid arthritis who underwent pelvic radiotherapy for cervical or endometrial cancer in a curative intent at the Gustave-Roussy Cancer Campus between 1990 and 2015 were reviewed for treatment-related toxicities. Acute and late effects were graded as per the Common Terminology Criteria for Adverse Events version 4.0 scoring system.
RESULTS: Eight patients with cervical cancer and three with endometrial cancer were identified. Median follow-up was 56 months. Median external beam radiotherapy dose was 45Gy. All patients received a brachytherapy boost using either pulse- or low-dose rate technique. Concomitant chemotherapy was used in seven cases. Median time from rheumatoid arthritis diagnosis to external beam radiation therapy was 5 years. No severe acute gastrointestinal or genitourinary toxicity was reported. One patient had grade 3 dermatitis. Any late toxicity occurred in 7 /11 patients, and one patient experienced severe late toxicities. One patient with overt systemic rheumatoid arthritis symptoms at the time of external beam radiation therapy experienced late grade 3 ureteral stenosis, enterocolitis and lumbar myelitis.
CONCLUSIONS: Pelvic radiotherapy, in the setting of rheumatoid arthritis, appears to be feasible, with potentially slight increase in low grade late events compared to other anatomic sites. Patients with overt systemic rheumatoid arthritis manifestation at the time of radiotherapy might be at risk of potential severe toxicities.

This article, devoted specifically to gynaecological cancers and their impact on the sexual and marital lives, is a collaboration between the psychologists and onco-gynaecologist within a cancer center. In oncology, gynaecological cancers\' treatments involve at the same time anatomical, physiological and functional modifications impacting, in a major way, on the sexual life of women. All the phases of the sexual answer can be touched. Beyond the physical and aesthetic consequences of the treatments, the sexual dysfunctions are generally caused by the deep psychological upheaval induced by the disease affecting a strongly invested female body. Female cancer is also a true test for the couple challenged in its emotional, functional and sexual cohesion: emotional distress, attachment link dysfunction, change of role within the couple, disordered state of communication. The couple cannot survive and find a harmonious intimate life without communication about sexual health between the medical team, the patient and her partner. All doctors and nurses must be able to initiate the subject throughout the course of care by respecting four prerequisites: to be aware of the importance to approach this subject, to create a climate of trust, to dare the questions and to respect the rhythm of the patient and her partner.

Gynecological cancers are lymphophilic cancers, which require the systematic inclusion of nodal areas in the clinical target volume when irradiation is planned in the therapeutic strategy for these cancers. Radiotherapy with intensity modulation that achieves better saving of healthy tissue is more often used. However, the very steep dose gradients generated by this technique can lead to poorer coverage of target volumes if they are not defined very precisely by taking into account their anatomical location. This is particularly true for lymph node target volumes, so the purpose of this article is to present recommendations from a literature review focused on this issue, in terms of selection and delineation of lymph node in irradiation of cervix and endometrial cancers.