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Medicina
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Addressing the Changes and Innovations in the Treatment of Gynecological...
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Addressing the Changes and Innovations in the Treatment of Gynecological Cancers

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Oncology".

Deadline for manuscript submissions: 31 October 2025 | Viewed by 1857

Special Issue Editor

Dr. Federico Ferrari

E-Mail Website
Guest Editor
Department of Obstetrics and Gynecology, Spedali Civili Brescia, 25156 Brescia, Italy
Interests: cervical cancer; HPV; vulvar cancer; ovarian cancer; endometrial cancer; surgery; laparoscopy

Special Issue Information

Dear Colleagues,

Constant developments in the medical field compel us to continually update and re-evaluate current clinical best practices. Gynecology is a particularly dynamic area where, in just a few years, technological advancements and increased knowledge have revolutionized clinical practices in the treatment of cancers. Technological innovations offer new surgical approaches, such as the use of sentinel lymph node technique in endometrial cancer, the pioneering adoption of endoscopy for the management of advanced ovarian cancer, and the critical as well as rational use of minimally invasive surgery for cervical cancer. Similarly, progress in the biological field has broadened the horizons for the medical treatment of oncological diseases, enabling the use of targeted therapies based on molecular profiles, in particular for endometrial and ovarian cancer, which are literally game changers in the scenario of adjuvant treatment. The scientific community is experiencing a highly productive period, resulting in continuous improvements in clinical care. Our Special Issue aims to gather the latest findings in these areas. We invite authors to contribute their most significant reports, including case studies, original research, review articles, and meta-analyses.

Dr. Federico Ferrari
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • ovarian cancer
  • endometrial cancer
  • cervical cancer
  • minimally invasive surgery
  • adjuvant treatment
  • targeted therapy
  • immunotherapy
  • endoscopy

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Published Papers (3 papers)

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Research

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17 pages, 1476 KiB  
Article
The Role of Initial Neutropenia and Neutrophil Dynamics in Personalizing Chemotherapy for Platinum-Resistant Ovarian Cancer
by Radu-Dumitru Dragomir, Alina-Gabriela Negru, Marina-Adriana Mercioni, Dorel Popovici, Sorin Săftescu, Andiana Roxana Blidari, Răzvan Ovidiu Curcă and Ioan Sas
Medicina 2025, 61(3), 470; https://doi.org/10.3390/medicina61030470 - 7 Mar 2025
Viewed by 720
Abstract
Background and Objectives: Platinum-resistant ovarian cancer (PROC) is associated with limited treatment options and poor outcomes, with median progression-free survival (PFS) and overall survival (OS) remaining suboptimal. Neutropenia, a common chemotherapy-related toxicity, has shown potential as a predictive biomarker for treatment efficacy [...] Read more.
Background and Objectives: Platinum-resistant ovarian cancer (PROC) is associated with limited treatment options and poor outcomes, with median progression-free survival (PFS) and overall survival (OS) remaining suboptimal. Neutropenia, a common chemotherapy-related toxicity, has shown potential as a predictive biomarker for treatment efficacy in several malignancies, including ovarian cancer. However, its role as a prognostic marker, particularly baseline neutropenia, remains underexplored. This study aimed to evaluate the prognostic and predictive value of initial neutropenia and neutrophil dynamics in PROC patients undergoing chemotherapy. Materials and Methods: A retrospective cohort study was conducted on 250 PROC patients treated between 2018 and 2022 at the OncoHelp Medical Center, Timișoara, Romania. Patients were stratified into two groups based on baseline absolute neutrophil count (ANC), as those with initial neutropenia (ANC < 2000/mm3) and without initial neutropenia (ANC ≥ 2000/mm3). Clinical outcomes, including tumor response, PFS, and OS, were assessed using RECIST 1.1 criteria. Hematological toxicities and neutrophil dynamics across three chemotherapy cycles were analyzed. Results: Patients with baseline neutropenia demonstrated significantly higher tumor response rates (47.05% vs. 27.27%; p = 0.002), longer median PFS (8.2 vs. 6.3 months; p = 0.008), and extended median OS (14.5 vs. 11.2 months; p = 0.002). Hematological toxicities, including Grade ≥3 neutropenia and febrile neutropenia, were more frequent in the neutropenic group (p < 0.001). Baseline ANC thresholds effectively predicted clinical outcomes, with an AUC of 0.79 for OS. Conclusions: Baseline neutropenia is a significant prognostic marker in PROC, correlating with improved tumor response and survival outcomes despite increased hematological toxicities. These findings support incorporating baseline ANC into treatment personalization strategies for PROC. Full article
(This article belongs to the Special Issue Addressing the Changes and Innovations in the Treatment of Gynecological Cancers)
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Review

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28 pages, 1773 KiB  
Review
The Vaginal Microbiota, Human Papillomavirus, and Cervical Dysplasia—A Review
by Justė Kazlauskaitė, Guoda Žukienė, Vilius Rudaitis and Daiva Bartkevičienė
Medicina 2025, 61(5), 847; https://doi.org/10.3390/medicina61050847 - 5 May 2025
Viewed by 605
Abstract
Background and Objectives: The relationship between the vaginal microbiota, human papillomavirus infection (HPV), and cervical precancerous lesions is a critical area of research, as it influences both the progression of HPV-related diseases and potential treatment strategies. New evidence suggests that Lactobacillus crispatus dominance [...] Read more.
Background and Objectives: The relationship between the vaginal microbiota, human papillomavirus infection (HPV), and cervical precancerous lesions is a critical area of research, as it influences both the progression of HPV-related diseases and potential treatment strategies. New evidence suggests that Lactobacillus crispatus dominance in the microbiota may protect against HPV persistence and speed the elimination of HPV. This study aims to explore the relationship between the vaginal microbiota composition and HPV infection, focusing on the impact of these factors on the development of cervical precancerous lesions. Materials and Methods: A comprehensive literature review was conducted using the PubMed database, focusing on studies that analyzed the association between the vaginal microbiota and HPV infection in the context of cervical dysplasia. This study was primarily based on clinical data on HPV integration in women with low-grade squamous intraepithelial lesions (LSILs), high-grade squamous intraepithelial lesions (HSILs), and cervical cancer. Results: Different types of vaginal microbiota communities (CSTs) have different pathogenic or protective potential. Healthy women predominantly exhibited CST I, with Lactobacillus crispatus as the dominant microorganism. CST IV, associated with increased anaerobic bacteria, was most common in HSIL and cervical cancer patients. Statistical analysis revealed that bacterial vaginosis (BV) was significantly associated with HPV persistence, with studies reporting a 1.8–3.4-fold increased risk (p < 0.05) of persistent HR-HPV infection in BV-positive women. Conclusions: Our literature review suggests that the composition of the vaginal microbiota can modulate the local immune response, the expression of viral oncogenes, and the integrity of the epithelial barrier. Furthermore, certain bacterial genes or metabolic pathways can be associated with a favorable or unfavorable outcome of the disease. Analysis of the vaginal microbiota could serve as an additional risk assessment tool, helping to distinguish between regressing and progressive precancerous conditions. Full article
(This article belongs to the Special Issue Addressing the Changes and Innovations in the Treatment of Gynecological Cancers)
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Other

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29 pages, 1335 KiB  
Systematic Review
Metformin: A Dual-Role Player in Cancer Treatment and Prevention: A Comprehensive Systematic Review and Meta-Analysis
by Imran Rangraze, Adil Farooq Wali, Mohamed El-Tanani, Mohamed Anas Patni, Syed Arman Rabbani, Rasha Babiker, Shakta Mani Satyam, Yahia El-Tanani and Manfredi Rizzo
Medicina 2025, 61(6), 1021; https://doi.org/10.3390/medicina61061021 - 30 May 2025
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Abstract
Background and Objectives: Metformin is said to reduce the incidences and deaths resulting from cancer in patients suffering from type 2 diabetes mellitus, but the results have been inconsistent. Perform a systematic review and meta-analysis concentrating on the different outcomes of several [...] Read more.
Background and Objectives: Metformin is said to reduce the incidences and deaths resulting from cancer in patients suffering from type 2 diabetes mellitus, but the results have been inconsistent. Perform a systematic review and meta-analysis concentrating on the different outcomes of several cancers while taking into account the impact of metformin use. Materials and Methods: As of 15 October 2024, the literature for Medline, Embase, and Web of Science was systematically searched. ROBINS-I and the RoB 2 tool were used for assessing the risk of bias in observational studies and randomized controlled trials (RCTs), respectively. The strength of the evidence with respect to the GRADE criteria was checked. Random effects meta-analyses were conducted alongside sensitivity analyses, subgroup analyses, and meta-regressions. By utilizing funnel plots as well as Egger’s test and trim-and-fill analysis, publication bias was evaluated. Results: In total, 65 studies were included in the final analyses: Metformin intake was linked to a lower risk of cancer (RR 0.72; 95% CI: 0.64–0.81, I2 = 45%). Significant reductions were observed in breast cancer (RR 0.68; 95% CI: 0.55–0.83) and colorectal cancers (RR 0.62; 95% CI: 0.51–0.76). Evidence certainty fluctuated from moderate to low, though analyses confirmed the results. Plofs funded the publication bias, but adjustment in trim-and-fill did not change the outcome significantly. Conclusions: Metformin intake seems to lower the chances of developing several types of cancers, especially breast and colorectal cancers, but the observational designs hinder determining the causal factors for observational studies. There is a need for large RCTs. Full article
(This article belongs to the Special Issue Addressing the Changes and Innovations in the Treatment of Gynecological Cancers)
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