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The treatment of gynecologic malignancies may impact fertility, and this is critical given that 15–20% of these neoplasms occur in women under 40 years of age. In addition, as a result of professional and personal goals, a considerable number of women are postponing childbearing until 30–40 years of age. Currently, international guidelines for the management of gynecologic cancers have incorporated suggestions for fertility preservation, particularly in the setting of early stage disease. Counseling regarding fertility preservation, particularly in cases where medically indicated, is recommended as it has been shown that patients who receive such counseling make better informed decisions and report improved quality of life after treatment.
In this Special Issue of the International Journal of Gynecological Cancer, the Invited Editors aimed to provide high-quality original research and updates on current and relevant issues regarding the preservation of fertility and hormonal function in cancer patients. The goal was to provide insightful and clinically relevant data and also to encompass a global representation of researchers and leading figures in the field. The aim was to include information regarding topics related to the most common disease sites impacting women’s cancers.
In cervical cancer, one of the most controversial topics in the treatment of early stage disease is the use of neoadjuvant chemotherapy either prior to fertility preservation or definitive therapy. In this issue we present data on neoadjuvant chemotherapy in pregnant patients with cervical cancer from renowned leaders in the field. In addition, for patients seeking future fertility but diagnosed with large (2–4 cm) cervical tumors, we provide updates on the literature on neoadjuvant chemotherapy prior to fertility-preserving surgery.
Our Special Issue will also feature novel approaches to gynecologic cancers and fertility preservation. One of our highlights is a paper from a collaborative group in Brazil presenting the results of their experience with uterine transposition in patients requiring radiotherapy after trachelectomy, and also a video of the technique in a 2-year-old girl with a pelvic tumor. Also, our field is moving towards less radical surgery where options for minimizing morbidity and peri-operative complications are key. To that end, we present three original papers on conization plus lymph node evaluation in patients with low-risk disease.
In this Special Issue we also feature papers on the latest updates on imaging modalities to assess patients prior to consideration of fertility preservation and also during pregnancy. There is also a complete review of cancer in pregnancy by leading authorities in this field. Similarly, we also provide details on the management of postpartum breast cancer. Hormone replacement therapy for patients with active disease, as well as those with a prior history of cancer, is discussed with an emphasis on potential risks for recurrence of disease. Rare tumors are also addressed with a very interesting article on preservation of fertility in patients with gestational trophoblastic disease.
As it pertains to patients with ovarian cancer, in this Special Issue we provide information on the latest literature on preservation of fertility in rare ovarian tumors, as well as a series on fertility preservation in patients with epithelial ovarian carcinoma. In addition, data on options for fertility preservation in patients with BRCA mutations, Lynch syndrome, and other genetic disorders are presented.
As Invited Editors, we hope that this Special Issue will contribute to the readership of the International Journal of Gynecological Cancer and help improve the quality of care, counseling and projected options for young patients with gynecologic cancers who wish to preserve fertility. We are grateful to all the authors who contributed their time and effort by submitting their best work to this Special Issue. We want this work to be of value to many who work every day to provide outstanding patient care to all women with gynecologic cancers.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.