Comparison of the efficacy of methotrexate and actinomycin D in the treatment of patients with stage I low risk gestational trophoblastic neoplasia (GTN).

BACKGROUND: Gestational trophoblastic neoplasia (GTN) refers to malignant lesions that arise from abnormal proliferation of placental trophoblast. Even in its metastatic forms GTN is curable with a cure rate of 90-100 %. Currently, methotrexate with or without folic acid, andactinomycin D is recommended for low risk GTN. The aim of this study is to compare the efficacy of methotrexate and actinomycin D as the first-line single chemotherapeutic agents for women with low-risk gestational trophoblastic neoplasia (LR-GTN). METHODS: A total of 30 women with LR-GTN were randomized to receive a weekly pulsed dose of 40 mg/m (2) of methotrexate intramuscularly (n=15) or a pulsed intravenous bolus of 1.25 mg/m (2) of actinomycin D every 2 weeks (n=15). An additional cycle was administered as consolidation treatment following normalization of the serum level of beta-human chorionic gonadotropin (˂10 IU/L). RESULTS: Complete remission was achieved in 53.3% of patients in the methotrexate group and 86.7% in the actinomycin D group (p˂0.04). The mean number of treatment cycles needed to achieve response was lower in the actinomycin D group (4.3 vs. 6.5). The mean duration from beginning of treatment till achieving complete remission was 9.6 weeks for the Act group and 13 weeks for the MTX group. CONCLUSION: Actinomycin D may be a better option than methotrexate as a first-line chemotherapy agent for patients with LR-GTN but larger multicenter randomized controlled trials should be conducted to establish the most appropriate regimen for these patients.

Diagnostic accuracy of magnetic resonance imaging versus clinical staging in cervical cancer.

BACKGROUND: Cervical cancer is the third most common gynecological cancer and a widespread malignancy in women, accounting for a large proportion of the cancer burden in developing countries. We compared accuracy of MRI staging with clinical staging and also concordance between the two methods for newly diagnosed patients with cervical cancer, using clinical staging as the reference. MATERIALS AND METHODS: This prospective study was conducted on 27 newly diagnosed patients with cervical cancer from Imam Khomeini hospital from June 2012 to Feb 2014. New cases of cervical cancer with positive PAP test were staged separately with a clinical exam based on the FIGO system by a gynecologist, oncologist and also with MRI by an expert radiologist. Then we compared the predicted stage for each patient with the two methods. RESULTS: Based on clinical staging 9 patients (33%) were observed at stage 1. MRI staging was in coordination with clinical staging in eight of them and for one patient MRI accorded stage 2B (88% concordance). CONCLUSIONS: MRI is a reliable noninvasive method with high accuracy for cervical cancer staging. Also presently it is easily obtainable, so we recommend using this technique along with clinical examination for staging cervical cancer patients. We also recommend to radiologists and residents of radiology to get experience with this method of staging.

A case of nephrotic syndrome associated with hydatiform mole.

The present case study is on a 16-year-old woman who was suffering from nephrotic syndrome after recovery from complete type of hydatiform mole. She was admitted in hospital because of proteinurea and hematuria. Then she was showing a generalized edema compatible with neprhotic syndrome. In her past medical history she had a suction curettage for hydatiform mole. After she received 4 courses chemotherapy, she completely recovered and ßhCG has fallen from 12127 IU/L to under 10 IU/mL. Then she showed generalized edema, proteinurea and hematuria compatible with nephritic syndrome. After six courses chemotherapy the symptoms of nephrotic syndrome and invasive mole diminished, she released from hospital and scheduled for follow-up.