Hyperthermic intraperitoneal chemotherapy (HIPEC) combined with cytoreductive surgery (CRS) has emerged as a promising locoregional treatment for advanced epithelial ovarian cancer, leveraging both enhanced intraperitoneal drug delivery and the synergistic cytotoxic effects of hyperthermia. This comprehensive review synthesizes current evidence on the biological rationale, technical considerations, patient selection, clinical outcomes, toxicity, and quality of life associated with HIPEC. The strongest data for HIPEC support its use at the time of interval cytoreductive surgery following neoadjuvant chemotherapy, where randomized trials demonstrate improvements in progression-free and overall survival without long-term detriment to quality of life. In contrast, evidence for HIPEC administered during primary CRS and recurrent disease remains mixed, with benefits highly dependent on patient selection and disease context. Key determinants of outcomes include completeness of cytoreduction, disease burden, performance status, and frailty, while chronologic age alone is not a contraindication. Although HIPEC is associated with increased perioperative morbidity, particularly nephrotoxicity, electrolyte disturbances, and hematologic complications, these risks are manageable at experienced centers and do not delay adjuvant therapy. Emerging data suggest that biomarkers such as homologous recombination deficiency status and CA-125 KELIM scores may help refine selection, while ongoing trials are evaluating HIPEC’s integration with modern maintenance therapies. HIPEC represents a valuable adjunct in the management of advanced ovarian cancer when applied in appropriately selected patients within specialized multidisciplinary settings.
This report reviews foundational and recent literature on maintenance therapy in ovarian cancer, both in the frontline setting and in platinum-sensitive recurrence. Bevacizumab and PARP inhibitors have been well established as frontline maintenance for BRCA wild-type and BRCA mutated or homologous repair deficient disease, respectively. For platinum-sensitive recurrence, PARP inhibitors are reserved for BRCA mutated disease; Bevacizumab can be considered if used alongside chemotherapy in management of the recurrence. Advanced epithelial ovarian cancer often responds well to initial chemotherapy and cytoreductive surgery, but rapid recurrence is common. Maintenance therapy with Bevacizumab or PARP inhibitors, in both frontline treatment and in platinum-sensitive recurrence, has improved progression-free survival. We review literature that informs recommendations for selection of maintenance regimens as well as recent findings narrowing some of their indications for use.
In this review, we will summarize the evidence, controversies, and ongoing evolutions in the use of minimally invasive surgery (MIS) among patients with gynecologic malignancies. The use of MIS has been adopted and transformed the surgical management of uterine cancer, improving surgical morbidity while preserving oncologic outcomes. In ovarian cancer, the use of MIS has been established for the determination of cytoreduction. Currently, MIS techniques have been shown to be feasible in the pilot lead into the LANCE trial, and the oncologic outcomes are forthcoming. While MIS showed worsened survival in radical hysterectomy for locally advanced cervical cancer, the indications for radical hysterectomy are declining and the oncologic safety of MIS in this new population of patients receiving simple hysterectomy continues to be evaluated. Gynecologists were early adopters and helped transform the use of MIS, which has improved surgical morbidity for patients. Oncologic equivalence has been shown in endometrial cancer and is being evaluated in ovarian cancer. While the use of MIS in cervical cancer with radical hysterectomy showed harm, surgical de-escalation continues in early-stage cervical cancer and the oncologic safety in this new, lower risk, population is yet to be determined.
This review examines existing data on how micronutrients, macronutrients, and dietary patterns impact the vaginal microbiome and bacterial vaginosis (BV), with the broader aim of informing future research and guiding evidence-based clinical counseling. The evidence linking dietary micronutrients and macronutrients to features of the vaginal microbiome is mixed, mostly observational, and limited by confounders. Vitamin D is the most studied micronutrient, with several studies suggesting lower levels may be associated with BV, though other studies show no association and limited randomized trials have conflicting results. Evidence for associations with vitamins A, C, E, B12, iron, and folate is sparse and inconsistent, as are data from studies examining associations with macronutrients (such as carbohydrates, proteins, fats, and fiber). Specific dietary patterns such as the Mediterranean, vegetarian, pescatarian, and dairy-rich diets also do not show consistent associations. Given the available data, dietary or micronutrient supplementation interventions to support vaginal health, decrease BV, or alter the vaginal microbiome cannot be routinely recommended to patients at this time. Most existing studies are observational and vary widely in how the vaginal microbiome and nutrient status are measured, often not adjusting for important confounders. In the future, larger studies, including, where warranted, carefully conducted randomized controlled trials, will be necessary to better understand the impact of diet on the vaginal microbiome.
This review summarizes current evidence regarding the pathogenesis, diagnosis, and management of recurrent BV, recurrent VVC, and persistent trichomoniasis while highlighting emerging therapies and research priorities. Recurrent BV is driven by persistence of a polymicrobial biofilm on vaginal epithelial cells, failure to restore a Lactobacillus-dominant vaginal microbiome following antibiotic therapy, and reinfection from untreated sexual partners. Emerging therapeutic approaches including live biotherapeutic products, vaginal microbiota transplantation, and male partner treatment seek to address these mechanisms beyond conventional antibiotic suppression. In contrast, recurrent vulvovaginal candidiasis primarily reflects host susceptibility and immune dysregulation rather than persistent infection, making long-term suppressive antifungal therapy the cornerstone of management while newer antifungal agents expand treatment options for selected patients. Persistent trichomoniasis most commonly results from reinfection or incomplete therapy, although antimicrobial resistance remains an important consideration requiring specialized diagnostic testing and alternative treatment regimens. Recurrent vaginitis is a common and frustrating clinical problem that substantially impairs women’s quality of life and accounts for frequent healthcare utilization. Although bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and trichomoniasis (TV) share overlapping signs and symptoms, the mechanisms underlying recurrence differ considerably and require disease-specific management strategies.
