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Outcomes of Non-Metastatic Gestational Trophoblastic Neoplasia: Twelve Year Experience from a Northern Thailand Tertiary Care Center

  • Suprasert, Prapaporn (Division of Gynecologic Oncology Department of Obstetrics and Gynecology Faculty of Medicine, Chiang Mai University) ;
  • Manopunya, Manatsawee (Division of Gynecologic Oncology Department of Obstetrics and Gynecology Faculty of Medicine, Chiang Mai University)
  • Published : 2015.09.02

Abstract

Gestational trophoblastic neoplasia (GTN) is the malignant form of gestational trophoblastic disease. In non-metastatic GTN, the outcomes of treatment are impressive with methotrexate (MTX) or actinomycin D. We retrospectively reviewed the outcomes of non-metastatic GTN treated at our center from January, 1999 to December, 2013. One hundred and nine patients were recruited to the study. The median age was 33.1 years and over 90% were referral cases. Abnormal vaginal symptoms developed in 37.6% while 56.4% were asymptomatic. The most common antecedent pregnancy was a complete mole (92.7%) with the median interval time from antecedent pregnancy to GTN development being 2.0 months. The median pretreatment B-hCG was 5,624 mIu/ml. The most common first line treatment was methotrexate (MTX) and folinic acid (91.7%) followed by weekly MTX (4.6%), etoposide+ MTX+actinomycin D (EMA) (2.8%), and actinomycin D (0.9%), with the median number of cycles at 5.0. The positive response to first line chemotherapy was 73.8%. The patients were given subsequent chemotherapeutic regimens after resistance to the first line therapy and showed a final remission rate of 89.9%.The significant factor that was frequently found in patients who were non-responders to the first line treatment was a hysterectomy procedure. Two patients developed lung metastasis and brain metastasis at one and four years after the first treatment, respectively. In conclusion, the outcomes of non-metastatic GTN were excellent. However, the patients need long term follow up due to the possibility of developing multiple organ metastases.

References

  1. Biscaro A, Braga A, Berkowitz RS (2015). Diagnosis, classification and treatment of gestational trophoblastic neoplasia. Rev Bras Ginecol Obstet, 37, 42-51. https://doi.org/10.1590/SO100-720320140005198
  2. Chapman-Davis E, Hoekstra AV, Rademaker AW,et la (2012). Treatment of nonmetastatic and metastatic low-risk gestational trophoblastic neoplasia: factors associated with resistance to single-agent methotrexate chemotherapy. Gynecol Oncol, 125, 572-5. https://doi.org/10.1016/j.ygyno.2012.03.039
  3. Froeling FE, Seckl MJ (2014). Gestational trophoblastic tumours: an update for 2014. Curr Oncol Rep, 16, 408-18. https://doi.org/10.1007/s11912-014-0408-y
  4. Gilani MM, Fariba B, Behtash N, et al (2013). The WHO score predicts treatment outcome in low risk gestational trophoblastic neoplasia patients treated with weekly intramuscular methotrexate. J Cancer Res Ther, 9, 38-43. https://doi.org/10.4103/0973-1482.110357
  5. Gamer EI, Garrett A, Goldstein DP, et al (2004). Significance of chest computed tomography findings in the evaluation and treatment of persistent gestational trophoblastic neoplasia. J Reprod Med, 49, 411-4.
  6. Maesta I, Growdon WB, Goldstein DP,et al (2013). Prognostic factors associated with time to hCG remission in patients with low-risk postmolar gestational trophoblastic neoplasia. Gynecol Oncol, 130, 312-6. https://doi.org/10.1016/j.ygyno.2013.05.017
  7. Manopunya M, Suprasert P (2012). Resistant gestational trophoblastic neoplasia patients treated with 5-fluorouracil plus actinomycin D. Asian Pac J Cancer Prev, 13, 387-90. https://doi.org/10.7314/APJCP.2012.13.1.387
  8. May T, Goldstein DP, Berkowitz RS,et al (2011). Current chemotherapeutic management of patients with gestational trophoblastic neoplasia. Chemother Res Pract, 2011, 1-12.
  9. Ngan HY, Kohorn EI, Cole LA,et al (2012). Trophoblastic disease. Int J Gynaecol Obstet, 119, 130-6. https://doi.org/10.1016/j.ijgo.2012.05.019
  10. Ozalp SS, Telli E, Oge T, et al (2014). Multicenter analysis of gestational trophoblastic neoplasia in Turkey. Asian Pac J Cancer Prev, 15, 3625-8. https://doi.org/10.7314/APJCP.2014.15.8.3625
  11. Seckl MJ, Sebire NJ, Fisher RA,et al (2013). Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 24, 39-50.
  12. Taylor F, Short D, Winter MC,et al (2015). A retrospective study to evaluate single agent methotrexate treatment in low risk gestational choriocarcinoma in the United Kingdom. Gynecol Oncol, 136, 258-63. https://doi.org/10.1016/j.ygyno.2014.12.024

Cited by

  1. Outcomes of Metastatic Gestational Trophoblastic Neoplasia: Fourteen Year Experience from a Northern Thailand Tertiary Care Center vol.17, pp.3, 2016, https://doi.org/10.7314/APJCP.2016.17.3.1357