IGCS Ramadan Nights-Session #3

Video Transcription

Video Summary

The third IGCS “Ramadan Nights” session (a recorded, interactive “Membogo Echo” meeting) featured multiple multidisciplinary gynecologic oncology case discussions moderated by David Atallah with co-chair Bassir Rifki. Participants were reminded to mute microphones, use chat/hand-raise for questions, and access the recording later via the IGCS Education 360 portal.

<strong>Case 1 (Tunisia):</strong> A 31-year-old with locally advanced rectal adenocarcinoma requiring pelvic radiation sought fertility preservation. The group debated uterine ventral fixation versus uterine transposition. Speakers favored transposition when technically feasible due to better uterine shielding, while emphasizing patient counseling about prognosis, ovarian reserve (AMH), and possible Lynch/MMR considerations.

<strong>Case 2 (Lebanon):</strong> A postmenopausal woman with stage IA grade 1 endometrioid carcinoma later developed a small vaginal vault recurrence. Consensus leaned toward definitive radiation (EBRT ± brachytherapy) rather than surgical excision, noting high cure rates in radiation-naïve cuff recurrences and limited added value of surgery.

<strong>Case 3 (Jordan):</strong> Vulvar synovial sarcoma discovered after presumed lipoma excision with positive margins. Re-excision (radical hemivulvectomy) showed no residual disease. Given rarity and uncertainty of benefit, the recommendation was close surveillance with frequent imaging; adjuvant radiation/chemotherapy was not clearly indicated after complete resection.

<strong>Case 4 (Tunisia):</strong> Recurrent high-grade serous ovarian cancer after prior R0 surgery and bevacizumab stopped due to Moyamoya syndrome. After strong chemo response, participants favored continued systemic therapy over secondary cytoreductive surgery (not meeting strict DESKTOP-style criteria), and highlighted need for BRCA/HRD testing to guide PARP options.

<strong>Case 5 (Lebanon):</strong> Early-stage uterine serous carcinoma with minimal residual tumor after hysteroscopy and negative staging. Management was described as a “gray zone”; chemotherapy (carboplatin/paclitaxel) ± vaginal brachytherapy was reasonable, while whole pelvic EBRT was considered overtreatment.

<strong>Case 6 (Egypt):</strong> Ascites with metastatic high-grade serous carcinoma on cytology and a PET-avid breast lesion raised concern for occult breast primary or dual primaries. Discussion emphasized more definitive breast evaluation (repeat biopsy/excision), additional tissue/IHC, and BRCA/HRD testing before finalizing adjuvant/maintenance strategy.

The session closed with thanks and an announcement that the final Ramadan Nights would feature Pedro Ramirez discussing the TRUST trial and service delivery in wartime conditions.

Keywords

IGCS Ramadan Nights

gynecologic oncology case discussions

fertility preservation pelvic radiation

uterine transposition

vaginal cuff recurrence endometrial cancer

definitive radiation EBRT brachytherapy

vulvar synovial sarcoma

recurrent high-grade serous ovarian cancer

BRCA HRD testing PARP inhibitors

uterine serous carcinoma adjuvant chemotherapy