Navigating Fertility Preservation Options in Gynecological Cancers: A Comprehensive Review

Chitoran, Elena; Rotaru, Vlad; Mitroiu, Madalina-Nicoleta; Durdu, Cristiana-Elena; Bohiltea, Roxana-Elena; Ionescu, Sinziana-Octavia; Gelal, Aisa; Cirimbei, Ciprian; Alecu, Mihnea; Simion, Laurentiu

doi:10.3390/cancers16122214

Cited by 5 publications

References 124 publications

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Cardiovascular Mortality in Patients with Gynecological Cancers: A Population-based Cohort Study

Yang,

et al. 2024

Preprint

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Objective The survival rate of gynecological cancers (GCs) has improved significantly in recent decades. Patients with GCs did not necessarily succumb to the primary cancer. Cardiovascular health might be a critical determinant of long-term survival. This study aimed to investigate the mortality rate and risk factors associated with cardiovascular disease (CVD) death in patients with GCs. Methods A total of 399,399 cases of GCs diagnosed between 2000 and 2020 from the Surveillance, Epidemiology, and End Results (SEER) database were included in this study. The standardized mortality ratio (SMR) for CVD mortality was estimated. Prognostic factors for CVD death were assessed using cause-specific hazard ratios with 95% confidence intervals within a competing risk model, considering non-cardiovascular death as a competing risk. Results Of the 399,399 patients with GCs, 117,551 (29%) died from GCs, and 16,371 (4.1%) died from CVD. Of the CVD deaths, 73.2% were attributed to heart disease. The SMR of CVD mortality was highest in survivors diagnosed before age 45 years, and the risk of CVD mortality remained elevated throughout the follow-up period compared to the general United States (US) population. In recent years, the SMRs for CVD mortality risk increased steadily in all subtypes of GCs, except for vulvar cancer. Older age, black race, localized stage, unmarried/single/divorced, vaginal and vulvar cancers, and radiation therapy were associated with a higher risk of CVD mortality. A nomogram was developed and validated using these variables to predict CVD death risk in patients with GCs. Conclusions The risk of CVD mortality in patients with GCs was increased and was significantly higher compared with the general US population. A nomogram was constructed and validated to forecast the risk of CVD mortality in individuals with GCs. More attention should be paid to cardiovascular health during diagnosis to improve survival rates.

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Cardiovascular Mortality in Patients with Gynecological Cancers: A Population-based Cohort Study

Yang,

et al. 2024

Preprint

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Vitamins, Coenzyme Q10, and Antioxidant Strategies to Improve Oocyte Quality in Women with Gynecological Cancers: A Comprehensive Review

Alexandru,

Nistor,

Motofelea

et al. 2024

Antioxidants

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Background: Gynecological cancers, including ovarian, cervical, and endometrial cancers, significantly affect both survival and reproductive health in women. Cancer treatments such as chemotherapy and radiotherapy can impair ovarian function, reducing oocyte quality and fertility potential. Objective: This review aims to evaluate how vitamins and antioxidants can enhance fertility and fertility preservation outcomes for women diagnosed with gynecological cancers, particularly in the context of assisted reproductive technologies (ART). Standard treatments for these cancers, including hysterectomy, bilateral salpingo-oophorectomy, radiation, and chemotherapy, often compromise ovarian function and oocyte quality. This review focuses on the potential role of these interventions in improving oocyte quality, thereby supporting successful fertility preservation and ART outcomes. Methods: A comprehensive narrative review of the current literature was conducted, examining the effects of vitamins A, C, D3, E, and Coenzyme Q10 on oocyte quality, particularly in the context of oxidative stress and inflammation induced by cancer and its treatments. Results: The evidence suggests that certain vitamins and antioxidants may mitigate oxidative damage and enhance oocyte quality. Vitamin A supports cumulus–oocyte complex integrity, while vitamins C and E act as potent antioxidants, reducing oxidative stress in ovarian tissues. Vitamin D3 enhances ovarian reserve markers and modulates inflammatory cytokines. Coenzyme Q10 improves mitochondrial function and reduces DNA damage, increasing oocyte viability and fertilization potential. Conclusions: The incorporation of specific vitamins and antioxidants into fertility preservation strategies may enhance oocyte quality in women with gynecological cancers. Although the preliminary findings are promising, further research is needed to determine optimal dosages and establish standardized protocols for clinical use.

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Pelvic Exenteration in Advanced, Recurrent or Synchronous Cancers—Last Resort or Therapeutic Option?

Rotaru,

Chitoran,

Zob

et al. 2024

Diagnostics

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First described some 80 years ago, pelvic exenteration remain controversial interventions with variable results and ever-changing indications. The previous studies are not homogenous and have different inclusion criteria (different populations and different disease characteristics) and methodologies (including evaluation of results), making it extremely difficult to properly assess the role of pelvic exenteration in cancer treatment. This study aims to describe the indications of pelvic exenterations, the main prognostic factors of oncologic results, and the possible complications of the intervention. Methods: For this purpose, we conducted a retrospective study of 132 patients who underwent various forms of pelvic exenterations in the Institute of Oncology “Prof. Dr. Al. Trestioreanu” in Bucharest, Romania, between 2013 and 2022, collecting sociodemographic data, characteristics of patients, information on the disease treated, data about the surgical procedure, complications, additional cancer treatments, and oncologic results. Results: The study cohort consists of gynecological, colorectal, and urinary bladder malignancies (one hundred twenty-seven patients) and five patients with complex fistulas between pelvic organs. An R0 resection was possible in 76.38% of cases, while on the rest, positive margins on resection specimens were observed. The early morbidity was 40.63% and the mortality was 2.72%. Long-term outcomes included an overall survival of 43.7 months and a median recurrence-free survival of 24.3 months. The most important determinants of OS are completeness of resection, the colorectal origin of tumor, and the presence/absence of lymphovascular invasion. Conclusions: Although still associated with high morbidity rates, pelvic exenterations can deliver important improvements in oncological outcomes in the long-term and should be considered on a case-by-case basis. A good selection of patients and an experienced surgical team can facilitate optimal risks/benefits.

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Navigating Fertility Preservation Options in Gynecological Cancers: A Comprehensive Review

Cited by 5 publications

References 124 publications

Cardiovascular Mortality in Patients with Gynecological Cancers: A Population-based Cohort Study

Cardiovascular Mortality in Patients with Gynecological Cancers: A Population-based Cohort Study

Vitamins, Coenzyme Q10, and Antioxidant Strategies to Improve Oocyte Quality in Women with Gynecological Cancers: A Comprehensive Review

Pelvic Exenteration in Advanced, Recurrent or Synchronous Cancers—Last Resort or Therapeutic Option?

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