Dae-Yeon Kim

Background: Cervical excisional treatment is associated with adverse obstetric outcomes. Although imiquimod has been explored as a conservative alternative in trials like TOPIC-3, its definitive role remains debated. We aimed to evaluate the long-term efficacy of a clinician-applied imiquimod strategy specifically in women aged under 35 years to verify its potential for fertility preservation. Methods: We conducted a retrospective, single-arm cohort study of nulliparous women aged under 35 years with Cervical Intraepithelial Neoplasia (CIN) 2 or 3 and no prior excisional therapy between October 2021 and March 2024. The primary outcomes were histological regression assessed immediately post-treatment (8 weeks) and during a prolonged follow-up period. Results: A total of 100 patients were included. The immediate regression rate following the 8-week imiquimod course was 96.0%, with an initial high risk Human Papillomavirus (hr-HPV) clearance rate of 57.1%. In the follow-up analysis, the sustained regression rate reached 91.0%, and the cumulative hr-HPV clearance rate rose to 70.5%. Notably, patients with CIN2 without HPV 16/18 achieved the highest regression rate (96.5%), successfully avoided or postponed surgical intervention. Conclusions: The clinician-applied imiquimod strategy offers a robust therapeutic impact, safely postponing surgical intervention for approximately one year in reproductive-aged women with CIN 2/3. This imiquimod strategy serves as an effective bridging therapy that preserves fertility without compromising clinical safety, providing a supportive clinical decision-making model for individualized non-surgical management.

Kim BR, et al. J Gynecol Oncol. 2025 Dec;37:e43. https://doi.org/10.3802/jgo.2026.37.e43

Lee YJ, et al. J Gynecol Oncol. 2025 Jun;36(6):e128. https://doi.org/10.3802/jgo.2025.36.e128

Hwang WY, et al. J Gynecol Oncol. 2025 Jan;36:e71. https://doi.org/10.3802/jgo.2025.36.e71

Bulky or multiple lymph node (LN) metastases are associated with poor prognosis in cervical cancer, and the size or number of LN metastases is not yet reflected in the staging system and therapeutic strategy. Although the therapeutic effects of surgical resection of bulky LNs before standard treatment have been reported in several retrospective studies, well-planned randomized clinical studies are lacking. Therefore, the aim of the Korean Gynecologic Oncology Group (KGOG) 1047/DEBULK trial is to investigate whether the debulking surgery of bulky or multiple LNs prior to concurrent chemoradiation therapy (CCRT) improves the survival rate of patients with cervical cancer IIICr diagnosed by imaging tests. The KGOG 1047/DEBULK trial is a phase III, multicenter, randomized clinical trial involving patients with bulky or multiple LN metastases in cervical cancer IIICr. This study will include patients with a short-axis diameter of a pelvic or para-aortic LN ≥2 cm or ≥3 LNs with a short-axis diameter ≥1 cm and for whom CCRT is planned. The treatment arms will be randomly allocated in a 1:1 ratio to either receive CCRT (control arm) or undergo surgical debulking of bulky or multiple LNs before CCRT (experimental arm). CCRT consists of extended-field external beam radiotherapy/pelvic radiotherapy, brachytherapy and LN boost, and weekly chemotherapy with cisplatin (40 mg/m²), 4-6 times administered intravenously. The primary endpoint will be 3-year progression-free survival rate. The secondary endpoints will be 3-year overall survival rate, treatment-related complications, and accuracy of radiological diagnosis of bulky or multiple LNs. ClinicalTrials.gov Identifier: NCT05421650; Clinical Research Information Service Identifier: KCT0007137.

Kim JH, et al. J Gynecol Oncol. 2024 Jan;35:e45. https://doi.org/10.3802/jgo.2024.35.e45