Peritoneal carcinomatosis-associated malignant bowel obstruction is a common feature that merits more attention in advanced and recurrent ovarian cancer. Decompressive gastrostomy is one of the most preferred methods to palliate distressing symptoms and maintain patients’ quality of life. We retrospectively identified 31 patients with ovarian cancer-associated MBO, who underwent decompressive CT fluoroscopy-guided percutaneous gastrostomy (CT-PG) between September 2015 and April 2023 at our institution. A systematic literature review was conducted for CT-guided gastrostomy in ovarian cancer. Prior to CT-PG, 27 (87%) patients underwent unsuccessful attempts at endoscopic gastrostomy or surgery due to bowel obstruction; a total of 55% had received ≥3 lines of chemotherapy. CT-PG could be successfully inserted in 25 of 31 (81%) patients without grade 4–5 complications. CT-PG insertion was feasible in 76% of patients with previous unsuccessful attempts of endoscopic gastrostomy. A total of 80% of patients with a successful insertion had considerable symptom relief and could tolerate fluid intake. Mean survival after the procedure was 44.4 days. Chemotherapy could be administered in 7 of 25 (28%) patients following the CT-PG insertion. CT-guided percutaneous gastrostomy is a safe procedure that effectively manages intractable symptoms of bowel obstruction in ovarian cancer. This minimally invasive technique should be emphasised as a routine instrument within the palliative management of MBO.

The Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) score has been proposed to facilitate patient selection for secondary cytoreductive surgery. However, this model has not been validated for low-grade subtypes of ovarian cancer. This study evaluates the reproducibility of a positive AGO score in predicting complete resection in recurrent low-grade epithelial cancers. We retrospectively analyzed 76 patients with recurrent grade-I serous, grade-I/II endometrioid, and mucinous ovarian cancers who underwent cytoreductive surgery between January 2001 and April 2023. Univariate and logistic regression analyses were performed to evaluate associations between clinical factors and surgical outcomes. Complete resection was achieved in 31 of 55 patients (56.3%) undergoing surgery at first recurrence and in 9 of 21 patients (42.9%) in subsequent treatment lines. Among patients experiencing first recurrence with a treatment-free interval of ≥6 months, the positive predictive value of the AGO score for complete resection was 70.6%. However, multivariate analysis revealed that Eastern Cooperative Oncology Group score (p = .62), International Federation of Gynecology and Obstetrics stage (p = 1.00), ascites (p = .14), and residual disease after primary surgery (p = .59) were not independent predictors of complete resection at first recurrence. Results were consistent in subgroup analyses, including serous and endometrioid subtypes with a treatment-free interval of ≥6 months. Ascites ≥500 mL was present in only 7.9% of patients, while 92.1% had no or low-volume (28 months was associated with higher complete resection rates (83.3% vs 50%, p = .038). Our study highlights a critical limitation of the AGO score in low-grade ovarian cancers. None of the clinical elements included in the AGO score were independently associated with surgical results. Despite the high positive predictive value, a positive AGO score may not reliably predict complete resection in patients with recurrent low-grade ovarian cancers and should be interpreted with caution.

Purpose: To describe clinical and virologic outcomes after topical 5% imiquimod for VaIN (vaginal intraepithelial neoplasia) within routine clinical practice, including the assessment of available post-treatment high-risk HPV status, and to evaluate its relationship with treatment outcomes. Methods: In this retrospective-cohort study, twenty patients with histologically confirmed VaIN (low-grade VaIN = 10, high-grade VaIN = 10) were evaluated between October 2020 and October 2022. The treatment varied based on the initial VaIN grade. The primary endpoint was complete response, defined as negative cytology and/or benign follow-up biopsy. Secondary endpoints included partial response (downgrading from high-grade to low-grade), persistence/progression, adverse events, and available post-treatment high-risk HPV status. Results: Among seventeen evaluable patients, a complete response was observed in 69.2% (9/13) imiquimod-treated patients. In high-grade VaIN imiquimod-treated patients, complete response was observed in 66.7% (6/9), while 33.3% (3/9) downgraded to low-grade VaIN on biopsy as a secondary outcome, with no persistence over a median follow-up of 24 months. Low-grade VaIN showed 75% clearance with either imiquimod or observation at a median follow-up of 24 months. In one low-grade imiquimod-treated, persistent HPV16 was observed, and the lesion progressed to high-grade VaIN; however, no invasive cancers were observed during follow-up. Adverse events related to imiquimod were mild; there were no discontinuations. Among baseline high-risk HPV positive imiquimod-treated patients, post-treatment follow-up HPV testing was available in a limited subset group, and clearance was confirmed in 44% (4/9) among those with follow-up testing and presented descriptively as exploratory. Conclusions: In this single-center retrospective cohort, outcomes after topical 5% imiquimod are reported as observed findings. Complete and partial responses were observed in high-grade VaIN with acceptable tolerability and no invasive events at available intermediate follow-up (median 24 months). Post-treatment HPV testing provided complementary virologic information alongside clinical outcomes, consistent with recommendations incorporating HPV testing into VaIN follow-up, and longer surveillance is required to assess long-term oncologic outcomes.