[ effect of consolidation treatment with intraperitoneal carboplatin in advanced epithelial ovarian cancers]

Background: The aim of this study was to assess the role of consolidative intraperitoneal chemotherapy with carboplatin in decreasing relapse and increasing survival in advanced epithelial ovarian cancers, as well as evaluation of its toxicity

Methods: In this clinical trial 30 patients with epithelial ovarian cancer in stages II-IV who had complete surgery [optimal debulking surgery] received six standard cycles of intravenous carboplatin and paclitaxel. They were enrolled through non-random sequential selection

The control patients were similar to case group in stage [II-IV] and pathology [epithelial ovarian cancer]

The control group was evaluated retrospectively through hospital files. This clinical trial performed in Gynecology Oncology department in Tehran Valiasr University Hospital, during 2005-2010. They including 18 cases as the intervention group receiving intraperitoneal chemotherapy and 12 patients as the control group with only retrospective follow-up. The cases received 3 cycles of 400 mg/m[2] intraperitoneal carboplatin every 21 days following intravenous chemotherapy. Relapse of disease was diagnosed as increasing or even doubling CA125 serum titer during one month, or any CA125 above 100 IU, or an abdominal or pelvic mass in ultrasound or physical exam. Mean survival of two and five years, progression-free interval [PFI], overall survival [OS], relapse, demographic parameters, drug toxicities, pathologic types of cancers in two groups were coded and compared using SPSS 14. Any PO.05 was considered as a significant difference

Results: The mean ages of cases and controls were 52.4+/-8.6 and 55.1+/-11.5 years. The mean duration of relapse-free survival was 13+/-8.6 months for the cases and 9.5+/-4.3 months for the control patients [not statistically different, P>0.05]

The mean overall survival for cases and controls were 39+/-16.5 and 30.8+/-16.2 months, respectively [no significant difference, P>0.05]

The frequency of drug toxicities in the cases was 5.6%, and consisted of mild-to-moderate abdominal pain, nausea and vomiting

Conclusion: It seems that consolidation therapy with intraperitoneal carboplatin may not increase overall survival, reduce relapse rate or decrease mortality, though it does not induce considerable side effects. Since the mean survival in the intervention group was nine months more than controls, this difference may be clinically significant

Major surgeries performed for gestational trophoblastic neoplasms in a teaching hospital in Tehran, Iran / 부인종양

OBJECTIVE: This study aim was to evaluate indications and outcomes of surgical interventions performed in patients with gestational trophoblastic neoplasm. METHODS: During January 1995 to December 2005, 110 patients with a diagnosis of persistent gestational trophoblastic neoplasm were treated in our Gynecologic Oncologic Department. Risk score calculation was carried out based on the revised FIGO 2000 scoring system for gestational trophoblastic neoplasm. Data from the patients' records and pathologic reports were analyzed by the chi-square and Fisher's exact tests and logistic regression. The Kaplan-Meier method including the log rank test was used to compare survival and recurrence. RESULTS: Eight patients did not complete their treatment and were excluded from the study. We evaluated treatment responses and outcomes in 102 patients. Seventy-nine patients (77.5%) responded fully to chemotherapy while 23 patients (22.5%) required surgery. Among 23 patients who underwent surgery, 10 cases (43.5%) had bleeding, and 13 cases (56.5%) had drug resistance. Several factors were found to be significantly different between the groups who responded to chemotherapy and those who needed surgery, including age (p=0.001), antecedent non-molar pregnancy (0.028), tumor stage (p=0.009), and pre-treatment risk scores (p=0.008). But, the total courses of chemotherapy (p=0.521), need to salvage chemotherapy (p=0.074), survival rates (p=0.714), and disease free survival rates (p=0.206) were not significantly different. CONCLUSION: The data suggest that age, antecedent non-molar pregnancy, tumor stage and the prognostic score are clinical predictors of need for surgery. But, it dose not seem that surgery have any effect on the total course of chemotherapy, need for salvage chemotherapy, and patient prognosis.

[Prevalence of ERCC1 overexpression and its relation with response to Cisplatin-based chemoradiation in cervical cancer]

Although current treatment options for cervical cancer rely on platinum-based chemoradiotherapy, individualized approaches to therapy may improve response or reduce unnecessary toxicity. Over expression of Excision repair cross-complementing 1 [ERCC1] has been associated with Cisplatin resistance in some tumors. We hypothesized that ERCC1 over expression is related to treatment response. 32 patients with cervical cancer were enrolled. Malignant tissue was isolated from pretreatment biopsies, and quantitative real-time reverse transcriptase polymerase chain reaction assays were performed to determine ERCC1 expression. Patients were divided to ERCC1 positive and ERCC1 negative. Response to chemoradiotherapy was evaluated and compared among the two groups. The mean age of participants was 56.6 +/- 12 years. Objective response was obtained in 24 patients [75%]. ERCC1 was 2.8 times higher in patients who did not respond to treatment compared with the responders [OR: 2.8]. Assessment of ERCC1 expression in tumoral tissue is possible in the clinical setting and predicts response to chemoradiotherapy. Further studies are necessary for final judgment

Low grade endometrial stromal sarcoma of uterine: review of 17 cases

Endometrial stromal sarcomas [ESS] are the second most common uterine sarcomas. Endometrial stromal sarcomas account for 0.25% of all uterine malignancies. Uterine sarcomas most often affect postmenopausal women. The aim of this retrospective study was to review the experience in the treatment and clinical outcome of low grade malignant endometrial stromal sarcoma. Seventeen patients with histologically proven low grade ESS in department of Gynecologic Oncology of the Vali-e-Asr Hospital, Tehran-Iran, between 1999 and 2008 were included in the analysis. Demographics, pathology, treatment, time to recurrence, salvage therapy and survival information was collected. The median age of our patients was 45.35 +/- 6.8 [range 36-61]. The median parity of the patients was 5 [range 0-8]. Most patients were diagnosed at FIGO stage I. The mean survival for patients with stage I and II was 73.5 +/- 35.09 and 57.6 +/- 5.37 months, respectively, with mortality rate of 5.9% through a median follow-up time of 68.82 +/- 30 months. Of 17 patients, seven cases [35.29%] were disease free at 6 years after hysterectomy. Radiotherapy was administered to four patients [23.53%]. Only one patient recurred at 10th month after surgery. Surgeries not preserving ovarian function were helpful to decrease the risk of recurrence compared with those sparing ovarian function

Long term oral etoposide as second-line therapy in recurrent epithelial carcinoma of the ovary

The activity and toxicity of etoposide in women with recurrent ovarian cancer was evaluated in a case series of women with recurrent ovarian cancer who had measurable disease.All patients had prior platinum-based chemotherapy and developed progressive disease. Etoposide was given as 50mg/day for 21 days every 4 weeks until progression of disease or prohibitive toxicity. Between December 1999 and January 2004, 32 patients were enrolled in this study.30 patients received a total of 133 cycles of etoposide. Median age was 49 years [range, 19 to 75]. The median number of etoposide cycles was 4 [range, 1 to 12]. There were 5 partial responses [16.6%]. The mean response duration was 4.8 months [range, 3.5 to 6], median progression-free interval [PFI] was 7 months [range, 3 to 13], and median survival time was 12.5 months [range, 1.3 to 36].The major toxicity was leukopenia. One patient required red blood cell transfusions, and the main non-hematologic toxicity was nausea and vomiting. There were no treatment-related mortalities. Although etoposide appears to exhibit modest activity in recurrent ovarian cancer after platinum-based therapy, response and survival durations are short

Vulvar carcinoma in pregnancy: a case report

Carcinoma of the vulva has commonly been recognized as a disease of postmenopausal women, but some cases have been reported in young women during pregnancy. Medical records were reviewed for a patient with vulvar carcinoma diagnosed in pregnancy. Using Medline and cross references, pertinent articles were sought and reviewed. A 28-year-old Afghan woman in her sixth pregnancy presented with a vulvar lesion. Subsequent biopsy revealed squamous cell carcinoma. The patient was treated with local excision. She had a cesarean section in her 36[th] week of pregnancy. She underwent modified radical vulvectomy with bilateral groin dissection four weeks after cesarean. Because of a grossly positive groin lymph node, she also underwent radiation therapy. She is alive without invasive cancer 7 months after diagnosis.This case demonstrates the need to biopsy all suspicious vulvar lesions, even in young and pregnant women