Gynaecological Cancers - improving treatment, risk prediction and rehabilitation

Endometrial cancer

Clinical studies leading to improved treatments and better risk prediction and indication for radiotherapy have been at the core of the research program. Main purpose has been to better tailor (adjuvant) treatment to individual characteristics and to personal wishes. To this end, all of the 4 PORTEC trials have been combined with extensive quality of life investigations, and 2 patient preferences studies have been done.

Central aims are to make individualised treatment, selecting the most effective treatments based on each patient’s individual tumour characteristics and reducing or avoiding treatment-related toxicities, available for every patient with endometrial cancer. Together with the international partners of the PORTEC-3 trial, the international TransPORTEC Consortium for translational research has been established and has been highly productive. Based on these results, the international platform of trials RAINBO has been initiated together with dr Judith Kroep from LUMC Medical Oncology, with 4 clinical studies for each molecular group, see https://www.msbi.nl/promise/Projects/TransPORTEC

Moreover, the research group has innovative projects into image-based AI applications for identifying molecular groups and risk predictions (dr N Horeweg), and has strong collaboration with the dept of Gynaecology of UMC Groningen (Prof Nijman, dr de Bruyn) in the research of immunological aspects of endometrial cancer.

The researchers of our research group have present and past leading positions in international organisations ESGO, IGCS, GCIG and EMBRACE, and in multiple Guideline Committees. Moreover, strong ties with the Dutch Patient Advocate Group Olijf have been established with collaborations in research, education, website information and international representation.

Cervical cancer

With the early involvement with the EMBRACE network and studies the research group has been at the forefront of improving treatment efficacy and outcomes for women with cervical cancer. Not only in the EMBRACE outcomes but also in our own outcome analyses the improvement of outcomes with image-guided modern intensity modulated external beam radiotherapy and up to date MRI-based brachytherapy have been clearly demonstrated.

The development of proton therapy for cervical cancer in the PROTECT collaboration is currently one of the main initiatives to investigate new treatments with less long-term impact on the cancer survivor, especially long-term bowel function, immune function and bone marrow reserve. The clinical trial has recently been initiated in phase 1 (standard photon therapy).

The SPARC study has been initiated to improve rehabilitation of women after completion of intensive radiotherapy and brachytherapy for gynaecological cancers, mainly cervical cancer. The nurse-led intervention has been developed and pilot-tested in a previous project and has been tested in a multicentre randomized trial, with participation of all Dutch gynaecological radiation oncology centres. Recently accrual was completed and results are awaited. Interestingly, the project and nationwide collaboration has already resulted in increased awareness, dedicated patient information leaflets, and collaboration and input into the Patient Advocacy website of Olijf, with improved standards of care for information and coaching in the recovery and rehabilitation phase.

Vulvar cancer

In addition to the research on endometrial cancer and cervical cancer, there is also significant involvement in studies in vulvar cancer, especially the GROINSS-VII en GROINSS-VIII studies into the role of radiation therapy in case of tumor positive sentinel nodes, and national studies into the primary treatment with chemoradiotherapy for locally advanced  vulvar cancer.