The Division of Gynecology provides all services involving the diagnosis, treatment and follow-up of gynecologic oncology patients. The Division includes the Unit of Gynecologic Oncology, mainly dedicated to chemotherapy treatments, and the Unit of Preventive Gynecology, mainly dedicated to diagnosis and treatment of genital cancer precursors. Each staff member is a fully-trained gynecologic oncologist responsible for various activities within the Division, including surgery (minor, major and mini-invasive), chemotherapy treatments, research, clinical trials, and early diagnosis.
Among the surgical activities particular attention is devoted to fertility preserving surgery in young patients with borderline ovarian tumors or early stage ovarian cancer. The division has also the facilities and the experience to perform major surgery such us extensive cytoreduction in patients with advanced ovarian cancer and pelvic exenteration with IORT (intraoperative radiotherapy) in patients with recurrent cervical cancer. A multi centre article has just been accepted for publication showing the benefit in terms of progression free survival in patients with ovarian cancer randomised to receive lymph node dissection, compared to no such resection. Overall survival however was unchanged and the toxicity and the morbidity of the operation was the significant factor in time of recovery of patients post operatively.
Another major area of interest is the search for less invasive surgical staging modalities to reduce morbidity while retaining adequate accuracy; a pilot study on sentinel node detection in cervical cancer and vulvar cancer has been conducted in cooperation with other EU centers.
In addition to their clinical and research activities members of the Division also have university and institutional teaching responsibilities that mainly involve training residents and fellows, but they are also involved in Continuing Medical Education (CME) programmes.
Clinical units belonging to the division:
The Unit of Gynaecologic oncology has a close cooperation with MRC CTU (Medical Research Council Clinical Trial Unit) and has conducted during the past 5 years several large trials aimed at defining the standard treatment for early and advanced ovarian cancer. We are one of the major contributors to the international ICON studies, which helped clarify the optimal first line treatment for patients with advanced ovarian cancer, the optimal second line therapy for platinum-sensitive relapsing patients, and the advantage of adjuvant therapy in patients with early ovarian cancer. In collaboration with the SENDO group a series of phase II agents have been tested in relapsed metastatic patients, most recently the drug ET743. This drug is a marine derived alkaloid. In patients who previously responded to platinum the response rate in this four-centre study was 43% with a median time to progression of 8 months. Only two partial responses were seen in 30 patients which were previously resistant to platinum. This data has been submitted to the EMEA who are yet to register to register the drug for this indication. The unit has also large experience in the treatment of rare malignancies such us germ cell and sex-cord stromal tumors of the ovary. >>
The Unit of Preventive Gynecology has experience in laser surgery for cervical, vaginal and vulvar pre-cancerous lesions, operative hysteroscopy, and transvaginal US for the detection and management of ovarian early cancer. Ongoing studies include HPV testing in the follow up of patients submitted to conization, HPV self-sampling, use of sonohisterography and liquid based endometrial cytology to detect early endometrial cancer, diagnostic accuracy of histoscanning. >>