Abstract

One of the most exciting and intensely complex aspects of clinical care has been the development, validation and implementation of new therapeutic modalities and agents in the care of our patients with gynecologic malignancies. Fortunately, the multi-faceted, multi-disciplinary, and multi-modality effort has brought not only longevity to our patients, but also provided new opportunities for previously unimaginable options in care. For instance systematic development of cytotoxic agents and refinement in surgical techniques in primary ovarian cancer has improved the median survival by a factor of 2 in the last 3 decades [ [1] Barnholtz-Sloan J.S. Schwartz A.G. Qureshi F. et al. Ovarian cancer: changes in patterns at diagnosis and relative survival over the last three decades. Am. J. Obstet. Gynecol. 2003; 189: 1120-1127 Abstract Full Text Full Text PDF PubMed Scopus (165) Google Scholar ]; administration of concurrent radio-sensitizing chemotherapy has reduced the hazard for progression and death by 30% to 50% in women with high risk localized and advanced stage cervix cancer [ [2] Green J.A. Kirwan J.M. Tierney J.F. et al. Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix: a systematic review and meta-analysis. Lancet. 2001; 358: 781-786 Abstract Full Text Full Text PDF PubMed Scopus (945) Google Scholar ]; and expansion of our surgical repertoire and equipment, particularly applied to endoscopy, has brought fertility-sparing options to selected patients with early stage cervix cancer [ 3 Smith J.R. Boyle D.C. Corless D.J. et al. Abdominal radical trachelectomy: a new surgical technique for the conservative management of cervical carcinoma. Br. J. Obstet. Gynaecol. 1997; 104: 1196-1200 Crossref PubMed Scopus (204) Google Scholar , 4 Covens A. Shaw P. Murphy J. et al. Is radical trachelectomy a safe alternative to radical hysterectomy for patients with stage IA-B carcinoma of the cervix?. Cancer. 1999; 86: 2273-2279 Crossref PubMed Scopus (227) Google Scholar , 5 Shepherd J.H. Mould T. Oram D.H. Radical trachelectomy in early stage carcinoma of the cervix: outcome as judged by recurrence and fertility rates. BJOG. 2001; 108: 882-885 PubMed Google Scholar , 6 Schlaerth J.B. Spirtos N.M. Schlaerth A.C. Radical trachelectomy and pelvic lymphadenectomy with uterine preservation in the treatment of cervical cancer. Am. J. Obstet. Gynecol. 2003; 188: 29-34 Abstract Full Text Full Text PDF PubMed Scopus (174) Google Scholar , 7 Ramirez P.T. Schmeler K.M. Malpica A. et al. Safety and feasibility of robotic radical trachelectomy in patients with early-stage cervical cancer. Gynecol. Oncol. 2009; Google Scholar ]. Nevertheless, the pace of measured therapeutic advances is becoming somewhat asymptotic, despite what appears to be sound rationale. While the outcomes of trials addressing intraperitoneal [ 8 Alberts D.S. Liu P.Y. Hannigan E.V. et al. Intraperitoneal cisplatin plus intravenous cyclophosphamide versus intravenous cisplatin plus intravenous cyclophosphamide for stage III ovarian cancer. N. Engl. J. Med. 1996; 335: 1950-1955 Crossref PubMed Scopus (1108) Google Scholar , 9 Markman M. Bundy B.N. Alberts D.S. et al. Phase III trial of standard-dose intravenous cisplatin plus paclitaxel versus moderately high-dose carboplatin followed by intravenous paclitaxel and intraperitoneal cisplatin in small-volume stage III ovarian carcinoma: an intergroup study of the Gynecologic Oncology Group, Southwestern Oncology Group, and Eastern Cooperative Oncology Group. J. Clin. Oncol. 2001; 19: 1001-1007 PubMed Google Scholar , 10 Armstrong D.K. Bundy B. Wenzel L. et al. Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N. Engl. J. Med. 2006; 354: 34-43 Crossref PubMed Scopus (2195) Google Scholar , 11 Katsumata N. Yasuda M. Takahashi F. et al. Dose-dense paclitaxel once a week in combination with carboplatin every 3 weeks for advanced ovarian cancer: a phase 3, open-label, randomised controlled trial. Lancet. 2009; 374: 1331-1338 Abstract Full Text Full Text PDF PubMed Scopus (618) Google Scholar ] and dose-dense adjuvant chemotherapy [ [11] Katsumata N. Yasuda M. Takahashi F. et al. Dose-dense paclitaxel once a week in combination with carboplatin every 3 weeks for advanced ovarian cancer: a phase 3, open-label, randomised controlled trial. Lancet. 2009; 374: 1331-1338 Abstract Full Text Full Text PDF PubMed Scopus (618) Google Scholar ] for primary ovarian cancer have focused new investigation (e.g. Gynecologic Oncology Group (GOG) 252, NCT00951496), both primary ovarian cancer and recurrent cervix cancer have seen large phase III trials recently report negative results [ 12 Bookman M.A. Brady M.F. McGuire W.P. et al. Evaluation of new platinum-based treatment regimens in advanced-stage ovarian cancer: a Phase III Trial of the Gynecologic Cancer Intergroup. J. Clin. Oncol. 2009; 27: 1419-1425 Crossref PubMed Scopus (574) Google Scholar , 13 Monk B.J. Sill M.W. McMeekin D.S. et al. A randomized phase III trial of four cisplatin (CIS) containing doublet combinations in stage IVB, recurrent or persistent cervical carcinoma: a gynecologic oncology group (GOG) study. J. Clin. Oncol. 2008; : 26 PubMed Google Scholar ] and identification of new efficacious agents for women recurrent endometrial cancer remains an exigent priority.

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