Assessing Post-Treatment Pathologic Tumor Response in Female Genital Tract Carcinomas: An Update

Abstract

In the last decades, several new therapeutic strategies have been introduced in the field of gynecologic oncology. These include neoadjuvant chemotherapy for high-grade serous tubo-ovarian carcinoma, hormonal fertility-sparing strategies for endometrial cancer, pressurized intraperitoneal aerosol chemotherapy (PIPAC) for surgically incurable peritoneal metastasis, and neoadjuvant treatments for locally advanced cervical carcinomas. All these recent advances lead to the development of novel scoring systems for the evaluation of pathological response related to specific treatments. In this regard, pathological evaluation of the morphological modifications related to these treatments and the definition of a tumor regression grading score have been introduced in clinical practice in order to achieve a more efficient prognostic stratification of patients affected by gynecological malignancies. The aim of the present paper is to provide a detailed review on the post-treatment pathological scoring systems in patients affected by gynecological malignancies.

Laparoscopic Radical Hysterectomy Combined with Neoadjuvant Chemotherapy for Cervical Cancer Patients Effectively Improves Immune Function

“…At present, early-stage cervical cancer is mostly Disease Markers managed by surgery, but still, 30% of patients fail to obtain favorable clinical results, with poor clinical prognosis and postoperative recurrence rates of up to 10-20%, mainly related to factors such as the International Federation of Gynecology and Obstetrics (FIGO) staging, choroidal cancer embolism, pelvic lymph node metastasis, and the specificity of its surrounding tissues. Thus, postoperative cervical cancer with adjuvant radiotherapy for comprehensive intervention to control postoperative recurrence has become a highly desired treatment modality for early-stage cervical cancer [19,20]. Neoadjuvant chemotherapy is administered to patients for 2-3 cycles followed by a subsequent treatment plan [21].…”

Prognostic Value of Mandard’s Tumor Regression Grade (TRG) in Post Chemo-Radiotherapy Cervical Cancer

“…The presence of some resorptive changes made the fibrosis assessment easier. For example, foamy histocytes, cholesterol clefts, foreign body reaction, necrosis and calcifications were specific for therapy-induced regression [18,59]. In addition, acellular mucin and mucinous changes can be observed.…”

“…This approach, as stated in several studies [10][11][12][13][14], achieves a good percentage of pathological complete response, and a very low rate of locoregional failure; indeed, in the phase II ROMA-2 study, which adopted CT/RT with concomitant boost followed by completion surgery, we registered a rate of pathological complete response of 50.5%, and only a 7% rate of 3-year locoregional failure [10][11][12][13][14][15][16]. In this setting, surgical pathology examination remains the gold standard for the assessment of residual disease [17][18][19]. The completion of surgery after CT/RT could provide relevant prognostic parameters.…”

“…Vessels could show myointimal thickening due to the deposit of acellular material. The endocervical non-neoplastic cells could have a reactive appearance that could simulate endocervical carcinoma, but they lack epithelial stratification, severe nuclear atypia and significant mitotic activity [18].…”