Asian Society of Gynecologic Oncology (ASGO) 2nd International Workshop on Gynecologic
Oncology was held in Kyoto Tokyu Hotel, on September 28th, 2012. A total of 213 medical
doctors and students from 11 countries (Hong Kong, India, Indonesia, Japan, Korea,
Malaysia, Philippines, Singapore, Taiwan, Thailand, and the USA) participated in the
meeting. In this workshop, there were a total of 23 presentations in 7 sessions including
two sponsored seminars (Table 1).
The first session was an educational session which consisted of 3 lectures on the
recent tends on gynecologic oncology. Dr. Konishi presented a multicenter study with
ovarian cancer patients of which clinical information including transvaginal ultrasonography
(TVS) finding of less than 12 months prior to the diagnosis of ovarian cancer was
available. He concluded that approximately half of ovarian cancer develop secondarily
from pre-existing, benign-appearing cysts or endometriotic cysts, whereas the remaining
half, typically high-grade serous ovarian cancer, seem to develop suddenly from normal-appearing
ovary. He also emphasized the limitation of screening programs using TVS. Dr. Aziz
reviewed current understanding of neo-adjuvant chemotherapy (NAC) in advanced ovarian
cancer and concluded that NAC prior to cytoreductive surgery was not superior to primary
cytoreductive surgery, but effective in terms of less morbidity and shorter hospitalization.
Dr. Devi gave a lecture on gestational trophoblastic disease (GTD) regarding diagnosis,
prognostic scoring, and treatment for primary/relapse/refractory disease, placental
site trophoblastic tumor, and choriocarcinoma. Notably, she underscored that a few
women died from the GTD, mainly because of late presentation and drug resistance.
She concluded that novel approaches with improved efficacy and reduced toxicity needed
to be identified and national registries of GTD in Asia should be established.
The second session comprised two symposia on the malignancies with poor prognosis,
cervical adenocarcinoma and uterine sarcomas. Three each of the lectures covered various
aspects of the two cancers including pathology, imaging studies, and clinical management.
Dr. Mikami presented his studies about cervical mucinous adenocarcinoma with gastric
immunophenotype. He proposed a concept of gastric-type adenocarcinoma (GAS) of the
cervix for this tumor with a distinct morphology. He stated that GAS showed unfavorable
clinical outcomes because of its aggressive behavior compared with usual-type of endocervical
adenocarcinoma. In addition, he mentioned that absence of human papillomavirus (HPV)
DNA in this particular type of tumor indicated that GAS arised via HPV-unrelated pathway.
Thus, he concluded that special considerations might be required for GAS in terms
of carcinogenesis, prevention, early detection, and treatment strategy. Dr. Shiozawa
presented a multicenter study for diagnostic criteria of minimal deviation adenocarcinoma
(MDA) and lobular endocervical glandular hyperplasia (LEGH) of the cervix. He concluded
that the combination of MRI, Pap smears, and gastric mucin test will improve the accuracy
of the preoperative diagnosis of MDA and LEGH. Next, Dr. Young-Tak Kim pointed out
current problems in diagnosis and treatment of cervical adenocarcinoma by comprehensive
review of his studies. He showed that adenocarcinoma differed from squamous cell carcinoma
in terms of epidemiology, etiology and prognosis. Cervical adenocarcinoma is an independent
prognostic indicator of poor survival in patients with early stage cervical cancer
with risk factors, regardless of the type of adjuvant radiotherapy after radical hysterectomy.
He concluded that novel treatment strategies specifically tailored to early stage
cervical adenocarcinoma were needed.
In uterine sarcoma symposium, Dr. Silverberg gave us a lecture about pathological
diagnosis of leiomyosarcoma and endometrial stromal sarcoma. He pointed out the difficulties
in their diagnosis. Dr. Chang presented how MRI can be used to diagnose uterine sarcomas.
He showed the usefulness of diffusion-weighted MRI in differentiating between leiomyomas
and malignant uterine tumors. Dr. Takano reviewed recent advances in the chemotherapeutic
treatment against uterine sarcomas. He showed doxorubicin, ifosfamide, and gemcitabine
plus docetaxel are the active agents against leiomyosarcoma. He also showed ifosfamide
plus cisplatin, ifosfamide plus paclitaxel, and carboplatin plus paclitaxel are the
active agents against uterine carcinosarcoma. Furthermore, bevacizumab and pazopanib
are promising molecular-targeted agents against uterine sarcomas.
The third session was about translational research for ovarian cancer. Dr. Goh presented
her research about histotype-specific copy number alterations in ovarian cancer. She
reported several potential drivers, including ERBB2 in mucinous, BRAF in serous, and
TPM3 in endometrioid histotypes. She concluded that identification of histotype-specific
copy number alterations can pave the way for histotype-specific targeted drug therapy.
Dr. Chan presented his research about AMP-activated protein kinase (AMPK) in ovarian
cancer. Decreased AMPK activity was significantly correlated with the up-regulation
of ERK/FOXM1 signaling cascade and advanced stage. He concluded that targeting AMPK
by either pharmaceutical or natural AMPK activators could be considered as an alternative
therapeutic regimen in the treatment of ovarian cancer. Dr. Hamanishi showed his research
about tumor immunology in ovarian cancer. He showed that a novel classification of
ovarian cancers could be established through the hierarchical clustering analysis
based on tumor-infiltrating immune cells and immunological suppressors. He concluded
that this result might support the application of Taylor-Made therapy based on the
immune status of the patients. Dr. Matsumura presented the results of expression microarray
analysis for ovarian clear cell carcinoma. He concluded that sorafenib might be effective
in the treatment of this disease.
The following two sessions dealt with surgical films with expert lectures on updated
gynecological cancer surgery including minimally invasive surgery. Dr. Tadayoshi Nagano
presented a video about abdominal radical trachelectomy. He showed this technique
might be feasible for women with early-stage cervical carcinoma who wanted to preserve
their fertility. Dr. Wang presented a video about laparoscopic surgery for gynecological
malignancies. Dr. Park presented a video about cytoreductive surgery for advanced
ovarian cancer. He argued that optimal cytoreduction could be achieved even in a case
with extensive upper abdomen involvement. Dr. Boggess presented a video about robotic
surgery for endometrial cancer, which included simple hysterectomy and retroperitoneal
lymphadenectomy. Dr. Lee presented a video about robotic radical hysterectomy for
cervical cancer. Dr. Young Tae Kim presented a video about robotic assisted radical
trachelectomy in early-stage cervical cancer.
Between the sessions, two sponsored luncheon and evening seminars covered pertinent
hot issues in the prevention and treatment of uterine cervical cancer, respectively.
In the luncheon seminar, Dr. Wilailak from Thailand and Dr. Konno from Japan gave
presentations on the recent movements of HPV vaccination in Asia. Dr. Wilailak presented
current topics about HPV vaccination in Asia. She insisted that support from the government
is necessary to increase the HPV vaccination rates. Dr. Konno presented how Japan
pursued the vaccination program. He also presented the current problems in vaccination
program in Japan. In the evening seminar, Dr. Takeshima and Dr. Mandai presented state
of the art in the management of locally advanced cervical cancer. Dr. Takeshima presented
the recent clinical trial that he conducted to evaluate the effectiveness of NAC followed
by radical hysterectomy plus postoperative chemotherapy without radiotherapy for stage
IB2-IIB cervical cancer. He concluded that this treatment strategy would offer the
advantage of minimizing radiation-induced morbidity, reserving radiotherapy for the
possible pelvic recurrence. Dr. Mandai presented current problems in treating stage
IIB cervical cancer. He emphasized the utility of "super-radical" hysterectomy and
showed a video of the surgery.
This workshop was successful with active discussions after every presentation. Unfortunately,
Chinese doctors were not able to attend the workshop due to the political issue that
Chinese and Japanese governments are facing. I hope that every member of the ASGO
will intimately communicate with each other for promoting both academic and social
achievements in the near future.