Clinical outcome of Iranian patients with advanced ovarian cancer with neoadjuvant chemotherapy versus primary debulking surgery.

OBJECTIVE: The aim of this study is to evaluate the results of neoadjuvant chemotherapy (NACT) and the impact of interval debulking surgery (IDS) on clinical outcomes of patients with advanced-stage ovarian cancer. METHODS: We performed a retrospective analysis on 92 patients with advanced ovarian cancer admitted to Vali-Asr Gynecologic oncology departments during 1996-2002. Comparison was made with results of neoadjuvant chemotherapy of 24 patients with unresectable advanced epithelial ovarian cancer treated with platinum- based NACT followed by IDS and clinical outcomes of 68 consecutive stage III and IV ovarian cancer patients treated with primary cytoreduction followed by platinum-based adjuvant chemotherapy. RESULTS: Primary cytoreductive surgery caused longer survival compared to neoadjuvant chemotherapy. Patients who underwent optimal interval debulking surgery (IDS) had a better progression free survival (PFS) (p=0.002) and overall survival (p=0.03) than those who did not. There were not significant differences between the two groups in complications of surgery. CONCLUSION: NACT followed by successful IDS can lead to high survival percentage in patients with chemoresponsive advanced ovarian cancer; although the result is more effective in those with optimal primary cytoreduction, we still got the same results with those with suboptimal primary cytoreduction.

Uterine sarcoma: clinicopathological characteristics, treatment and outcome in Iran.

OBJECTIVE: Uterine sarcomas are rare and heterogeneous tumors with histopathological diversity characterized by rapid clinical progression and a poor prognosis. The aim of this study was to investigate clinical and histopathological characteristics together with treatment and outcome of Iranian patients with uterine sarcomas. MATERIALS AND METHODS: Records of 57 patients with histologically verified uterine sarcoma treated at the Vali-e-Asr Hospital were reviewed (1999-2004). RESULTS: The lesions were 19 leomyosarcoma (LMSs), 17 malignant mixed Mullerian tumors (MMMT), 16 endometrial stromal sarcomas (ESSs), 3 unspecified sarcomas, 2 rabdomyosarcomas. Median age at diagnosis was 50 (17-81) years. Clinical stages (based on FIGO) were 30 with stage I disease, 9 with stage II, 12 with stage III and 6 with stage IV. Only one patient did not undergo surgery and most cases with LMS and ESS were treated with simple total hysterectomy (STH). Forty patients (out of 57) received adjuvant radiotherapy. The median follow-up period was 19 (2-96) months and median disease free period was 16 (1-86) months. The overall survival rates after 1, 2, and 5 years were 71%, 58% and 52%, respectively. Survival was related to histological type of ESS (p=0.0018), grade I (p=0.0032) and early stage (p=0.045) significantly, but was not linked to postoperative irradiation. However, local recurrence rate was significantly improved after adjuvant radiotherapy. Twenty-one patients had relapse, 16 in the pelvic and 5 in extrapelvic sites. CONCLUSION: Based on the findings in this series, prognosis is dependent on histopathological subtype, grade and tumor stage. Adjuvant radiotherapy decreases local recurrence rate, but without significant impact on survival.

Results of cervical cone excision biopsy in iran.

AIMS: The prevalence of cervical cancer in a developing country, and diagnostic therapeutic value of knife conization for CIN, indications, cytopathologic results and complications of conization, were evaluated. METHODS: This retrospective- descriptive study concerned 44 cases that underwent conization. RESULTS: The age range of patients was 18-75 (mean=43), and parity ranges were from 0-10 (mean 4-5), ten cases were post-menopausal. The main indication was inability to visualize the entire T zone (19 cases) that was more prevalent in post-menopausal (5 cases and 14 cases premenopausal). The most common pap smear result was HSIL in 16 cases before conization. The most common colposcopic biopsy result was moderate dysplasia in 16 cases. Two cases had invasive cancer on colposcopic- biopsy: one of them had ASCUS in pap smear result and another one HSIL. The most common histologic result after conization was mild dysplasia in 23 cases. Four cases had invasive cancer in histology of the cervix with conization. Active hemorrhage occurred in 2 cases and urinary infection in 1 case after conization. CONCLUSIONS: Pap smear results in screening of cervical cancer are not reliable and colposcopy is more acceptable for LSIL and ASCUS. All gynecologist should develop the skill to perform accurate knife conization, because the classical indications for conization continue to be valid, and it has low risk of complications.

Intraoperative frozen sections for assessment of female cancers.

Frozen sections offer an important and helpful adjunct to intraoperative diagnosis and its use has greatly impacted on the care of gynecological oncology patients. Frozen section diagnosis is a reliable method for surgical management of gynecology oncology patients. Sensitivity of frozen section is acceptable and its specificity is almost perfect. False negative rate is low and false positive rate is negligible. Diagnostic problems can occur due to technical limitations especially in mucinous and borderline tumors. A good communication established between clinicians and pathologists is necessary to obtain more accurate results and to minimize the number of deferred cases.

Female genital warts.

Genital warts are a clinical manifestation of HPV types 6 and 11, and are estimated to affect 1% of sexually active adults aged between 15 and 49. HPV leading to a broad spectrum of human diseases, ranging from benign warts to malignant neoplasms, depending on the location of the lesion, the immune status of the patient and the type of HPV. Current therapies for human papillomavirus-associated disease are based on the excision or ablation of involved tissue and are associated with a high frequency of recurrent disease, discomfort and costs.