{"id":19789,"date":"2026-06-06T12:48:37","date_gmt":"2026-06-06T08:48:37","guid":{"rendered":"https:\/\/medscriptum.org\/?p=19789"},"modified":"2026-06-06T12:48:55","modified_gmt":"2026-06-06T08:48:55","slug":"the-11th-annual-gimpha-conference-emerging-frontiers-and-controversies-in-gynecologic-oncology","status":"publish","type":"post","link":"https:\/\/medscriptum.org\/en\/the-11th-annual-gimpha-conference-emerging-frontiers-and-controversies-in-gynecologic-oncology\/","title":{"rendered":"The 11th Annual GIMPHA Conference: Emerging Frontiers and Controversies in Gynecologic Oncology"},"content":{"rendered":"

On May 31, Tbilisi hosted one of the year\u2019s most extensive and influential medical symposia. The 11th Annual Conference of the Georgian International Medical and Public Health Association (GIMPHA<\/a>) convened more than 600 domestic and international delegates. The scientific forum was structured across six core tracks: pediatrics, oncology, radiology, infectious diseases, mental and somatic health, and chronic pain management.<\/p>\n

Among the diverse presentations, exceptional interest was garnered by a granular analysis of endometrial carcinoma staging\u2014a clinical dilemma catalyzed by the ongoing re-evaluation of current evidence and the readouts of newly published interventional trials.<\/p>\n

The keynote was delivered by Dr. Eter Natelauri, MD, PhD Candidate, Clinical Director of the Kristina Kila Oncology Center, Radiation Oncologist, and ASTRO (American Society for Radiation Oncology) Ambassador to Georgia. Her presentation addressed a critical, polarizing question currently facing gynecologic oncology: Should endometrial cancer treatment algorithms be modified to integrate the updated FIGO 2023 classification system?<\/p>\n

The answer, methodically outlined by the speaker, reveals a multilayered clinical landscape where staging discrepancies directly impact patient outcomes.<\/p>\n

One Pathology, Two Staging Frameworks<\/strong><\/p>\n

For over a decade, the staging of endometrial cancer was governed by the FIGO 2009 criteria. This legacy system relied on a purely anatomical framework, categorizing malignancies strictly on the basis of macroscopic tumor extension. Because this globally adopted model is easily reproducible, it remains the structural foundation for current American clinical practice guidelines.<\/p>\n

In contrast, the updated 2023 system shifts away from isolated anatomy. This revised paradigm incorporates histological risk profiling, stratifying tumors into aggressive versus non-aggressive phenotypes. Crucially, the 2023 scheme introduces upgraded criteria for lymphovascular space invasion (LVSI); the presence of substantial LVSI can independently upstage a malignancy that is otherwise anatomically confined to the uterus. Molecular classification also represents a cornerstone of the new system, integrating four distinct genetic subgroups.<\/p>\n

Additionally, the 2023 update introduced a novel staging tier: Stage IA3. This category was specifically designed to reclassify cases that were previously assigned to more advanced stages. It applies explicitly to the synchronous presentation of low-grade endometrioid carcinomas concurrently involving the endometrium and the ovary, a clinical scenario now recognized to possess an inherently favorable prognosis.<\/p>\n

The Barriers to Universal Implementation<\/strong><\/p>\n

Intriguingly, two of the world’s leading oncological organizations evaluated the exact same body of clinical evidence yet arrived at diametrically opposed conclusions, igniting a significant conceptual debate across the Atlantic.<\/p>\n

The presentation delineated the primary factors driving the American medical community\u2019s hesitation to universally adopt the FIGO 2023 guidelines. The core issue rests on the fact that several fundamental criteria within the new classification remain highly contested.<\/p>\n

The National Comprehensive Cancer Network (NCCN) made a definitive decision to retain the traditional, purely anatomical classification within its guidelines. Their position is grounded in practical utility: the legacy model guarantees global reproducibility, whereas universal molecular profiling is not globally accessible. Furthermore, American experts argue that the poorly defined boundaries of the new criteria necessitate additional validation through prospective clinical trials. The consensus among US consensus panels is that while molecular and histological elements should be utilized for risk stratification, they should not fundamentally alter the numerical stage of the disease.<\/p>\n

First and foremost, the interobserver reproducibility of the new classification remains a subject of intense debate; significant discordance is frequently observed when different pathologists evaluate identical biopsy specimens. This issue is compounded by ambiguous terminological boundaries, which frequently cause patients with vastly different clinical risk profiles to be stratified into the identical stage. Moreover, the system groups biologically distinct tumor types into single categories, complicating the selection of targeted adjuvant therapies.<\/p>\n

The most formidable barrier to routine clinical implementation, however, is socioeconomic and technological. The functional execution of the 2023 model relies on universal molecular profiling. Due to its high cost, this diagnostic workflow is inaccessible across most of the developing world. In the context of Georgia’s healthcare infrastructure, it imposes an acute “financial toxicity” on individual patients.<\/p>\n

Conversely, the European Society for Medical Oncology (ESMO) has fully embraced the new classification, directly embedding molecular profiling into its staging workflows. Under the European framework, the genetic subtype of the tumor directly dictates the definitive stage, drastically upstaging or downstaging the disease based on intrinsic biological behavior. A parallel ideological schism exists between the leading subspecialty societies: the European Society of Gynaecological Oncology (ESGO) has already published its endorsement of the new guidelines in The Lancet Oncology<\/i>, whereas the American Society of Gynecologic Oncology (SGO) has refrained from taking a similar step.<\/p>\n

To illustrate the clinical implications of this divergence, Dr. Natelauri presented three practical case studies. Each scenario demonstrated how the application of different staging models to the exact same patient yields radically discordant adjuvant treatment recommendations.<\/p>\n

These case studies underscored that the variance between the two systems is not merely a matter of dry academic debate, but a critical variable that directly shapes therapeutic volumes and, consequently, patient survival.<\/p>\n

Current Evidence and Future Outlook<\/strong><\/p>\n

The keynote emphasized that the data driving all pivotal clinical trials to date were generated using the legacy staging system. Furthermore, major ongoing phase III trials, whose readouts are anticipated over the coming years, continue to stratify and randomize cohorts based on the older, anatomical framework. This reality implies that the conflict between the two classifications is not a transient logistical hiccup; it represents a long-term structural challenge that will fragment clinical practice for years to come.<\/p>\n

Parallel to the debates surrounding staging, another paradigm shift is unfolding in the management of advanced and recurrent endometrial cancer. Innovative immunotherapy regimens are rapidly disrupting standard-of-care protocols. Recent landmark trials indicate that combining immune checkpoint inhibitors with standard chemotherapy significantly prolongs progression-free and overall survival, particularly within specific molecular subtypes.<\/p>\n

As these modern, biomarker-driven regimens become the frontline standard of care, it becomes clinically imperative for the treating oncologist to know precisely which staging framework a laboratory pathology report is utilizing.<\/p>\n

In her concluding remarks, Dr. Natelauri called upon the professional community to implement several pragmatic measures. To prevent clinical ambiguity, she emphasized that pathology departments should ideally report the disease stage under both the 2009 and 2023 systems simultaneously. Furthermore, it is critical that multidisciplinary tumor boards document both classifications alongside the patient\u2019s mismatch repair and molecular status. Until international harmonization is achieved, the practical mandate for every clinical team remains clear: therapeutic decisions must be meticulously tailored on an individual, case-by-case basis.<\/p>\n","protected":false},"excerpt":{"rendered":"

On May 31, Tbilisi hosted one of the year\u2019s most extensive and influential medical symposia. The 11th Annual Conference of the Georgian International Medical and Public Health Association (GIMPHA) convened more than 600 domestic and international delegates. The scientific forum was structured across six core tracks: pediatrics, oncology, radiology, infectious diseases, mental and somatic health, […]<\/p>\n","protected":false},"author":12,"featured_media":19790,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1673,1675,5891,1677,1594],"tags":[5899,5892,5893],"class_list":["post-19789","post","type-post","status-publish","format-standard","has-post-thumbnail","category-campaigns","category-georgian-events","category-gimpha","category-international-events","category-news","tag-eter-natelauri","tag-figo","tag-gimpha"],"acf":[],"_links":{"self":[{"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/posts\/19789","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/users\/12"}],"replies":[{"embeddable":true,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/comments?post=19789"}],"version-history":[{"count":1,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/posts\/19789\/revisions"}],"predecessor-version":[{"id":19793,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/posts\/19789\/revisions\/19793"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/media\/19790"}],"wp:attachment":[{"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/media?parent=19789"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/categories?post=19789"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/tags?post=19789"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}