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02 July 2023, Volume 39 Issue 7 Previous Issue   

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Neoadjuvant chemotherapy for locally advanced cervical cancer：controversies and current status. ZHANG Jing-ni, CAI Jing, WANG Ze-hua 2023, 39(7): 677-683.  DOI: 10.19538/j.fk2023070102 Abstract ( )   Concurrent chemoradiation is the first choice of treatment for locally advanced cervical cancer. However，in a radiation resource-limited setting or as a part of efforts to avoid radiation-induced adverse effects，neoadjuvant chemotherapy followed by radical hysterectomy has been used as an alternative in many countries and regions. Multiple clinical trials have confirmed the feasibility and safety of neoadjuvant chemotherapy with cisplatin or carboplatin plus paclitaxel. Compared with primary radical surgery，preoperative neoadjuvant chemotherapy can improve resection rate，reduce postoperative complications，and decrease the demand for adjuvant radiotherapy，while the long-term survival benefits are still controversial. Compared with concurrent chemoradiation，neoadjuvant chemotherapy followed by radical surgery is associated with a shorter progression-free survival，but it does not compromise the overall survival，and the spectrum of toxic effects varies between these two treatment strategies. In conclusion，neoadjuvant chemotherapy has strengths and limitations in treatment for locally advanced cervical cancer，and it is necessary to balance its advantages and disadvantages and make personalized decisions. Hopefully，efforts to optimize chemotherapy regimens and predict responsiveness to chemotherapy are able to improve the chemotherapy response rate in the near future，conferring more benefits for cervical cancer patients.

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Effect of neoadjuvant chemotherapy on reducing postoperative radiotherapy in locally advanced cervical cancer. KANG Yan-jun, ZHAO Shu-ping 2023, 39(7): 683-687.  DOI: 10.19538/j.fk2023070103 Abstract ( )   Neoadjuvant chemotherapy（NACT） can shrink the tumor of locally advanced cervical cancer （LACC） before surgery and decrease postoperative lymph node metastasis，positive surgical margin，parametrial infiltration and other recurrence risk factors，thus reducing the use of radiotherapy and radiotherapy doses，and shortening radiotherapy length. NACT combined with radical surgery is beneficial to the sexual quality of young patients and can be used as the first treatment option for LACC. Establishing NACT sensitivity prediction model will help us to develop individual treatment regimens for patients，which is the direction of our future study.

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Prediction of neoadjuvant chemotherapy sensitivity in cervical cancer. ZHANG Qian-qian, BAI Hua, WANG Meng-xin, WU Su-hui, 2023, 39(7): 687-692.  DOI: 10.19538/j.fk2023070104 Abstract ( )   Cervical cancer is one of the common malignant tumors in women，which seriously threatens women's life and health. At present，neoadjuvant chemotherapy（NACT）is an important adjuvant treatment for cervical cancer before surgery or radiotherapy in China. However，due to the tumor heterogeneity of cervical cancer and individual differences in patients' sensitivity to chemotherapy，not all patients can benefit from NACT treatment. A simple and effective means to predict patients' chemotherapy sensitivity to NACT in a timely manner would help clinicians to adjust treatment plans in a timely manner and prevent patients who are not sensitive to NACT from missing the best opportunities for surgery or radiotherapy. This article presents the research progress on the prediction of NACT sensitivity in cervical cancer in terms of histopathology，biomarkers of patients and models of cancerous organs from patients，which will help to identify whether patients will benefit from NACT，stratify patients with different sensitivities，and promote the precise treatment of cervical cancer.

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Neoadjuvant chemotherapy for advanced endometrial cancer. ZHAO Bing-bing, LI Li 2023, 39(7): 693-698.  DOI: 10.19538/j.fk2023070105 Abstract ( )   Endometrial cancer is a common malignant tumor of female malignant tumors and its incidence is increasing in recent years. About 80%-90% of EC patients are in the early stage. In the early stage of EC，surgery is the main treatment，and adjuvant radiotherapy or chemotherapy is performed according to the risk factors after surgery. The 5-year survival rate is more than 80%. However，the 5-year survival rate is only 15% for patients with advanced EC. For advanced patients with limited methods of treatment，surgery，chemotherapy，radiotherapy and other comprehensive treatment methods are used. Similar to advanced ovarian cancer，maximum cytoreductive surgery for advanced EC is associated with prognosis. Patients with stage Ⅲ/Ⅳ EC，if surgery is available，should undergo maximum tumor reduction to achieve no residual lesions as far as possible. However，for patients with systemic multiple metastases and contraindications，neoadjuvant chemotherapy（NACT）is the preferred option followed by surgery，which is aimed at improving tumor resection rate and reducing surgical complications. NACT for advanced endometrial cancer include chemotherapy agents，immunotherapy，antiangiogenic therapy，targeted therapy，and hormonal therapy. This article reviews the relevant studies of NACT in the treatment of advanced endometrial cancer，in order to understand the application status of NACT in advanced EC and provide reference for clinical diagnosis and treatment.

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Neoadjuvant chemotherapy in vulvar cancer.  DENG Hao, WANG Jian-liu 2023, 39(7): 698-701.  DOI: 10.19538/j.fk2023070106 Abstract ( )   The incidence rate of vulvar cancer is low and the management is complex，especially in patients with locally advanced vulvar cancer. In recent years，researches on neoadjuvant chemotherapy for vulvar cancer have gradually increased. Through neoadjuvant chemotherapy，tumor lesions can be reduced to avoid surgical removal of organs such as the urethra and anus，preserving organ function，and improving patient quality of life. However，there are still relatively few studies at present，and most of them are retrospective studies. Further research is still needed to evaluate the therapeutic effect and neoadjuvant chemotherapy regimen.

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Neoadjuvant chemotherapy combined with interval debulking surgery for advanced ovarian cancer. NI Meng-dong, WU Xiao-hua 2023, 39(7): 701-706.  DOI: 10.19538/j.fk2023070107 Abstract ( )   Treatment modalities for newly diagnosed advanced ovarian cancer include primary debulking surgery （PDS） and neoadjuvant chemotherapy combined with interval debulking surgery（NACT-IDS）. The role of NACT in the treatment of advanced epithelial ovarian cancer has long been controversial. On the one hand，it increases the rate of optimal cytoreduction while reducing perioperative complications. On the other hand，its impact on prognosis is vague and it may lead to platinum-resistance. Therefore，it is of great significance to choose optimal candidates for NACT. The traditional models to predict R0 resection of ovarian cancer is mainly composed of CT-based Suidan criteria and Fagotti laparoscopic score. Fudan University Shanghai Cancer Center recommends a Fudan criteria with higher predictive ability based on DWI/MR. Regardless of whether NACT is prescribed or not，R0 resection is an independent prognostic factor for ovarian cancer，which should be pursued tirelessly by gynecologic oncologists.

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Effect of neoadjuvant chemotherapy on the surgical outcomes of interval debulking surgery for advanced ovarian cancer. ZHU Lian-cheng, LIN Bei. 2023, 39(7): 706-711.  DOI: 10.19538/j.fk2023070108 Abstract ( )   The combination of neoadjuvant chemotherapy （NACT）with interval debulking surgery（IDS）for advanced ovarian cancer patients can help achieve satisfactory tumor cytoreductive surgery and reduce postoperative disease rates. However， further research is needed to explore the impact of NACT on surgical outcome evaluation. Effective evaluation of newly diagnosed advanced ovarian cancer patients， including pathology， clinical indicators， and imaging and selection of suitable patients to use NACT-IDS are beneficial for reducing postoperative complications，improving surgical satisfaction，and increasing the possibility of minimally invasive surgery. However， postoperative survival may not be benefited，and chemotherapy drug resistance and the risk of tumor recurrence may increase. This suggests that gynecological oncologists should carefully choose NACT. Multi-disciplinary treatment is necessary to achieve the best treatment effect.