Publications by authors named "Mitra Modarres Gilani"

7 Publications

  • Page 1 of 1

The Outcome of Locally Advanced Cervical Cancer in Patients Treated with Neoadjuvant Chemotherapy Followed by Radical Hysterectomy and Primary Surgery.

Iran J Med Sci 2021 Sep;46(5):355-363

Department of Oncology, Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran.

Background: In recent years, before radical hysterectomy, neoadjuvant chemotherapy (NACT) has been administered to patients with locally advanced cervical cancer to shrink large tumors. It has been reported that this treatment significantly reduces the need for radiotherapy after surgery. The current study aimed to assess the outcome (survival, recurrence, and the need for adjuvant radiotherapy) of locally advanced cervical cancer in patients treated with NACT followed by radical hysterectomy and primary surgery.

Methods: In a retrospective cohort study, the records of 258 patients with cervical cancer (stage IB2, IIA, or IIB), who referred to Imam Khomeini Hospital (Tehran, Iran) from 2007 to 2017 were evaluated. The patients were assigned into two groups; group A (n=58) included patients, who underwent radical hysterectomy and group B (n=44) included those, who underwent a radical hysterectomy after NACT. The outcome measures were the recurrence rate, five-year survival rate, and the need for adjuvant radiotherapy.

Results: The median for overall survival time in group A and B was 113.65 and 112.88 months, respectively (P=0.970). There was no recurrence among patients with stage IB2 cervical cancer in group B, while the recurrence rate in group A was 19.5% with a median recurrence time of 59.13 months. Lymph node involvement was the only factor that affected patients' survival. The need for postoperative adjuvant radiotherapy in group B was lower than in group A (P=0.002).

Conclusion: NACT before the hysterectomy was found to reduce the need for postoperative radiotherapy in patients with locally advanced cervical cancer according to disease stages. As a direct result, adverse side effects and the recurrence rate were reduced, and the overall survival rate of patients with stage IIB cervical cancer was increased.
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September 2021

Vulvar cancer in Iran: Retrospective study over 20 years (1998-2018).

J Family Med Prim Care 2019 Apr;8(4):1465-1469

Department of Gynecology Oncology, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background: We did not have any data about vulvar cancer - as a fourth cause of gynecological cancer in the worldwide - in our country.

Study Design: Our study is designed to evaluate the frequency, stage and outcome of patients with vulvar cancer.

Materials And Methods: In this retrospective observational study, we studied patients' records with diagnosis of vulvar cancer who referred to department of gynecology oncology, Emam-Khomeini Hospital (EKH), Tehran, Iran, between January 1998 and December 2018. A total of 106 cases of vulvar cancers were found in the records of outpatient oncology clinic of medical university of Tehran university. Survival was estimated using the Kaplan-Meier analysis with SPSS version of 24.

Results: Mean age of the 106 patients in the study was 59.2 years. The most site of tumor involvement was major labial (39.1%). Vulvar cancer significantly was more in multiparous ( < 0.001) and menopause patients ( < 0.001). Squamous Cell Carcinoma was the most pathology of vulvar cancer (72.2%). Ninety patients (84.9%) had surgery as a primary treatment and 48 (53.3%) of these patients received adjuvant radiotherapy or chemoradiation after surgery. Mean duration of patient's follow up was 82.4 ± 68.3 month. Five-year survival of our patients in all stages was 71%.

Conclusions: Our findings are located between developed and underdeveloped countries. Our patients are diagnosed nearly in earlier stages of disease and 84.9%t of them had surgery as a primary treatment, so earlier surgery resulted in good survival of patients.
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April 2019

Placenta Site Trophoblastic Tumor and Choriocarcinoma from Previous Cesarean Section Scar: Case Reports.

Iran J Med Sci 2018 Jul;43(4):426-431

Department of Gynecology Oncology Valiasr, Imam Khomeini Hospital, Tehran University of Medical Science, Tehran, Iran.

Choriocarcinoma and placental site trophoblastic tumor (PSTT) are rare varieties of gestational trophoblastic disease (GTD). PSTT alone constitutes about 1-2% of all trophoblastic tumors, which presents at early reproductive age and the serum beta-hCG level is much lower than choriocarcinoma. This tumor usually invades the myometrium and its depth of penetration is a prognostic factor. The first case report is regarding a 33-year-old woman with vaginal bleeding 3 months after abortion. The ultrasound exhibited heterogeneous and hypervascular mass related to previous cesarean scar. Serum beta-hCG level was 67 mIU/ml and chemotherapy was administered. However, due to severe vaginal bleeding and no regression in mass size, total abdominal hysterectomy was performed. Histopathological examination and IHC staining confirmed PSTT from previous cesarean section. The second case report is regarding a 33-year-old woman with cervicoisthmic choriocarcinoma, which was mistaken as cesarean scar pregnancy. The ultrasonography and elevated serum beta-hCG level suggested cesarean scar pregnancy. The patient was treated with methotrexate without any effect. Eventually, cervicoisthmic choriocarcinoma was detected after hysterectomy. A diagnostic error was made leading to possible uterus perforation along with incorrect chemotherapy that resulted in a life-threatening condition. It is concluded that PSTT and choriocarcinoma are the two important differential diagnoses of sustained elevated beta-hCG when imaging evidence is also suggestive. Although PSTT and cervicoisthmic choriocarcinoma are rare, they do exist and are on the rise.
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July 2018

The prognostic role of preoperative serum CA125 levels in patients with advanced endometrial carcinoma.

Cancer Biomark 2017 Aug;20(2):135-141

Reproductive Health, Nursing & Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran.

Background: Lifetime risk of developing endometrial cancer is 2.17%. There is controversy regarding the predictive value of Cancer Antigen 125 (CA125) in endometrial cancer as well as the significance of its relationship with prognostic factors and appropriate cut-off value.

Objective: The aim of the present study was to investigate the prognostic role of CA125 in advanced endometrial carcinoma and determination of the appropriate cut-off value.

Methods: A sample of 91 patients was retrospectively selected from a population of 501 patients suffering from endometrial cancer during 1995 to 2015 in accordance with the inclusion criteria. The relation between clinicopathological variables and CA125 were analyzed. In order to determine sensitivity and specificity of various cut-off levels, receiver operating characteristic (ROC) curve analysis was performed for associated factors confirmed by logistic regression analysis.

Results: In 35% of patients, CA125 values were 35 u/ml, and in 52%, the values were equal to or greater than 20 u/ml. High preoperative CA125 was significantly related with advanced stage, ovarian involvement, omental metastasis, and myometrial invasion equal to or greater than 50%. According to the ROC curve, the suitable cut-off value for CA125 in advanced stage (sensitivity = 73%, specificity = 55%, positive predictive value = 18%, negative predictive value = 78%) and myometrial invasion equal to or greater than 50% (sensitivity = 64%, specificity = 61%, positive predictive value = 47%, negative predictive value = 74%) was 20 u/ml. Further, the suitable cut-off value for CA125 in involvement of the ovaries (sensitivity = 77%, specificity = 72%, positive predictive value = 31%, negative predictive value = 95%) and omental involvement (sensitivity = 70%, specificity = 70%, positive predictive value = 22%, negative predictive value = 95%) was 35 u/ml.

Conclusions: In endometrial carcinoma, due to the relationship of CA125 with numerous prognostic factors, it is recommended that CA125 measurement be included in preoperative evaluation. In case of high CA125 levels, complete surgical staging including lymphadenectomy and omentectomy should be considered.
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August 2017

Resistance to single-agent chemotherapy and its risk factors in low-risk gestational trophoblastic neoplasms.

J Obstet Gynaecol Res 2015 May 10;41(5):776-83. Epub 2014 Dec 10.

Gynecology Oncology Department, Valiasr Hospital, Faculty of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, I.R of Iran.

Aim: Gestational trophoblastic neoplasm (GTN) is a rare disease which is classified into high- and low-risk groups. While the high-risk patients require combination therapy, the low-risk groups respond to single-agent chemotherapy. We studied resistance to single-agent chemotherapy and its risk factors among the low-risk GTN patients in Iran.

Methods: We followed 168 low-risk GTN patients who were treated between 2001 and 2011 in Valiasr Hospital, Tehran, Iran. We used a case-control design and studied odds ratios (OR) and corresponding 95% confidence intervals (CI) to evaluate association between drug resistance and different personal and clinical variables.

Results: Resistance to sequential single-agent chemotherapy was 19%, although all patients had a complete remission after a combination of chemotherapy and/or surgery. Patients who had International Federation of Gynecology and Obstetrics scores of 5-6 - considered as, the intermediate risk group - had a 14-fold higher resistance compared with the low score patients (OR = 14.28, 95% CI = 5.54-36.81). We found higher risk of resistance among patients with metastasis (OR = 8.42, 95% CI = 2.44-29.07), large tumor size (>3 cm) (OR = 7.73, 95% CI = 1.93-30.91), high β-hCG (>100 000 IU/L) (OR = 5.86, 95% CI = 1.07-32.02) and/or a diagnosis more than 4 months after pregnancy (OR = 3.30, 95% CI = 1.08-10.02), compared with their reference group. We found no priority for the different chemotherapy regimens.

Conclusion: Intermediate risk GTN patients had a higher risk of resistance to chemotherapy compared with low-risk patients. Clinical trials and cost-effectiveness studies are needed to suggest a better treatment program for the intermediate risk group.
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May 2015

Does Postevacuation β -Human Chorionic Gonadotropin Level Predict the Persistent Gestational Trophoblastic Neoplasia?

ISRN Obstet Gynecol 2014 24;2014:494695. Epub 2014 Mar 24.

Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran.

β -human chorionic gonadotropin (HCG) level is not a reliable marker for early identification of persistent gestational trophoblastic neoplasia (GTN) after evacuation of hydatidiform mole. Thus, this study was conducted to evaluate β -HCG regression after evacuation as a predictive factor of malignant GTN in complete molar pregnancy. Methods. In this cross-sectional study, we evaluated a total of 260 patients with complete molar pregnancy. Sixteen of the 260 patients were excluded. Serum levels of HCG were measured in all patients before treatment and after evacuation. HCG level was measured weekly until it reached a level lower than 5 mIU/mL. Results. The only predictors of persistent GTN are HCG levels one and two weeks after evacuation. The cut-off point for the preevacuation HCG level was 6000 mIU/mL (area under the curve, AUC, 0.58; sensitivity, 38.53%; specificity, 77.4%), whereas cut-off points for HCG levels one and two weeks after evacuation were 6288 mIU/mL (AUC, 0.63; sensitivity, 50.46%; specificity, 77.0%) and 801 mIU/mL (AUC, 0.80; sensitivity, 79.82%; specificity, 71.64%), respectively. Conclusion. The rate of decrease of HCG level at two weeks after surgical evacuation is the most reliable and strongest predictive factor for the progression of molar pregnancies to persistent GTN.
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July 2014

Frequency of different types of ovarian cancer in Vali-e-Asr Hospital (Tehran University of Medical Sciences) 2001-2003.

Pak J Biol Sci 2007 Sep;10(17):3026-8

Department of Gynecology Oncology, Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Purpose of this study was to report histology specific age adjusted ovarian cancer incidence rates from 2001-2003 in Tehran University Hospital (valie-Asr hospital). This was a case series study including all microscopically confirmed cases of ovarian malignancies from 2001-2003. There were 152 cases of ovarian cancer, 102 (67.1%) epithelial type, 26 (17.1%) germ cell tumors, 14 (9.2%) sex cord stromal and 10 (6.6%) metastatic ovarian tumors. Present results were compatible with results from nonwestern countries. Epithelial type tumors and sex cord-stromal tumors were more prevalent after the age 50 (40 and 44.4% consequently). Germ cell tumors were more prevalent before 20(16 cases, 61.5%) (chi2 = 42.54, p-value = 0.000). Stage of disease in epithelial type tumors was advanced in most of patients but most germ cell tumors and sexcord-stromal tumors were stage I (chi2 = 19.6, p-value = 0.000). Present study showed that epithelial ovarian tumors in comparison to western countries are less frequent in Iran but still this histologic type is the most prevalent type of ovarian malignancy in this area of the world. Of course in younger patients we can predict more probability of germ cell tumors with more localized disease and better prognosis.
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September 2007