El Ayachi Zineb, Gabro Alexandra, Camprodon Guillaume, Chopra Supriya, Maingon Philippe, Chargari Cyrus
Radiation Oncology Department, groupe hospitalier universitaire Pitié-Salpêtrière, Sorbonne Université, 75013 Paris, France.
Department of Radiation Oncology and Medical Physics, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
Cancer Radiother. 2024 Dec;28(8):719-726. doi: 10.1016/j.canrad.2024.10.002. Epub 2024 Nov 22.
The field of gynaecologic oncology has evolved rapidly in recent years, largely driven by advances in both radiotherapy and systemic therapies. These innovations have reshaped the management of key gynaecologic cancers, including cervical, endometrial, vaginal, and vulvar cancers, leading to more personalized and effective treatment approaches. This review explores pivotal clinical trials conducted between 2023 and 2024 that have potentially modified current practices. Through an extensive analysis of randomized controlled trials and meta-analyses, we examine the evolving role of radiotherapy, the integration and sequencing of immunotherapy, and the refinement of neoadjuvant and adjuvant treatments based on molecular classifications. The combination of immunotherapy with chemoradiotherapy has shown promising outcomes, particularly in patients with locally advanced cervical cancer. For endometrial cancer, molecular profiling has enabled a more precise classification of tumour subtypes, leading to better-targeted adjuvant therapies that reduce unnecessary interventions and increase treatment efficacy. In parallel, radiotherapy has advanced with the increasing use of modern techniques such as intensity-modulated radiotherapy and more recently the developments of adaptive treatments in order to minimize exposure to healthy tissue, thereby reducing toxicity and enhancing patient quality of life. Integration of image-guided brachytherapy and expansion of capabilities with newer generation of brachytherapy applicators have also increased possibilities to achieve efficient local treatments, including in very advanced cases. However, despite progress in common gynaecologic cancers, the management of rare cancers such as vulvar and vaginal cancers continues to face challenges due to limited clinical research and treatment data. This review highlights the transformative potential of these innovations and emphasizes the need for continued research and personalized treatment strategies to optimize patient outcomes in gynaecologic oncology.
近年来，妇科肿瘤学领域发展迅速，这在很大程度上得益于放射治疗和全身治疗的进展。这些创新重塑了包括宫颈癌、子宫内膜癌、阴道癌和外阴癌在内的主要妇科癌症的治疗方式，带来了更具个性化和更有效的治疗方法。本综述探讨了2023年至2024年间进行的可能改变当前临床实践的关键临床试验。通过对随机对照试验和荟萃分析的广泛分析，我们研究了放射治疗不断演变的作用、免疫治疗的整合和序贯应用，以及基于分子分类对新辅助治疗和辅助治疗的优化。免疫治疗与放化疗联合应用已显示出有前景的结果，尤其是在局部晚期宫颈癌患者中。对于子宫内膜癌，分子谱分析能够更精确地对肿瘤亚型进行分类，从而带来靶向性更强的辅助治疗，减少不必要的干预并提高治疗效果。与此同时，随着调强放疗等现代技术的日益应用以及最近自适应治疗的发展，放射治疗取得了进展，以尽量减少对健康组织的照射，从而降低毒性并提高患者生活质量。图像引导近距离放疗的整合以及新一代近距离放疗施源器功能的扩展，也增加了实现高效局部治疗的可能性，包括在非常晚期的病例中。然而，尽管常见妇科癌症取得了进展，但外阴癌和阴道癌等罕见癌症的治疗由于临床研究和治疗数据有限，仍然面临挑战。本综述强调了这些创新的变革潜力，并强调需要持续研究和个性化治疗策略，以优化妇科肿瘤学患者的治疗结果。
