Clinical efficacy analysis of preoperative neoadjuvant chemotherapy with high-dose dense paclitaxel plus cisplatin in Stages IB2, IIA2, IIB cervical cancer in Iran.

PURPOSE OF INVESTIGATION: In Iran, the authors use neoadjuvant chemotherapy (NACT) prior to surgery in cervical cancer due to limited access to the radiotherapy and very prolonged waiting time in accession to radiotherapy. The study was done to analyze the efficacy of the NACT with high dose-dense paclitaxel and cisplatin before radical surgery on cure rate, survival rate, and the progression of free survival rate of bulky tumor of cervical cancer in Stages 1B2, IId A2, and IIB. MATERIALS AND METHODS: Fifty-two patients with cervical cancer in Stages Ib2, IIA2, and IIB were selected, and responding patients to chemotherapy were scheduled to undergo radical hysterectomy and bilateral pelvic lymphadenectomy with or without para-aortic lymphadenectomy. RESULTS: Fifty out of 52 patients with a median age of 50 years were evaluable for clinical response. Thirty-two patients (64%) responded to the NACT including six (12%) with a complete clinical response. There was no statistical relationship between clinical response, tumor stage and size, and parametrical involvement, however, patients with higher grade of tumor, adenocarcinoma or tumor in upper 2/3 of vagina showed a higher probability of no response to chemotherapy. Downstaging after NACT in all stages was statistically significant regarding pathologic findings and clinical response (p = 0.002). Five-year survival was 88% and factors affecting survival and disease-free survival were pathological response and tumor site based on cox-regression analysis. Overall recurrence rate was 20% and tumor size was the only significant relevant factor for recurrence (p = 0.017). CONCLUSION: Combined regimen of chemotherapy in locally advanced cervical cancer proved to be valuable and efficacious without any late complications.

To peritonealise or not to peritonealise? A randomised trial at abdominal hysterectomy in Iran.

We conducted a trial to determine whether non-closure of the visceral and parietal peritoneum alters the intraoperative or post-operative course at abdominal hysterectomy. This was a parallel-group double-blind randomised controlled trial was performed on 66 women who underwent abdominal hysterectomy with or without salpingo-oophorectomy. Twenty-seven were allocated to the control 'closed' group and 39 women to the study 'open' group. The main outcome measures were operative time, estimated blood loss, postoperative pain assessed by visual analogue scale and amount of postoperative analgesia. The study was conducted in the Department of Gynecological Oncology in a university teaching hospital. The operative time was shorter (P < 0.05) and the time to ambulation without assistance was significantly shorter in study group. There were no difference in postoperative pain, blood loss, amount of postoperative analgesia and antibiotics in the two groups. Peritoneal closure at abdominal hysterectomy provides no immediate postoperative benefits while unnecessarily lengthening surgical time and anaesthesia exposure. We suggest that the traditional practice of visceral and parietal closure be abolished at abdominal hysterectomy.

Daily low-dose oral etoposide for recurrent epithelial ovarian cancer after platinum-based therapy.

The activity and toxicity of oral etoposide in women with recurrent ovarian cancer are described from a case series of women who had measurable disease. All patients had had previous platinum-based chemotherapy. Etoposide was given as 50 mg/day for 21 days every 4 weeks until there was progression of the disease or prohibitive toxicity. Twelve patients were enrolled into this study. Ten patients received a total of 48 cycles of etoposide; the median number of cycles was 4 (range 1-11). There were two partial responses (20%; 95% CI, 0-45%). The responses lasted 3.5 and 6 months. Median progression-free interval (PFI) was 7.5 months (range 5.5-11), and median survival time was 8.5 months (range 1.2-21.5). The main haematological toxicity was leukopenia and no treatment-related death occurred. Although etoposide appears to exhibit activity in recurrent ovarian cancer, response and survival durations are short, with a high rate of complications.