Determination of Clinical Process and Response Rate to Treatment in Patients with Gestational Trophoblastic Neoplasia (GTN) with Low and High Risk and Evaluation of Their First Pregnancy Outcome
Background: The present study was conducted to determine the response to treatment in patients with GTN, the survival rate and to investigate the outcomes of first pregnancy after chemotherapy.
Materials and Methods: The treatment protocol was based on the FIGO Staging of GTN and the Modified WHO Prognostic Scoring.
Results: Complete remission was achieved with MTX in 100% of the low-risk patients and with combination therapy in 91% of the high-risk cases. Out of 27 low-risk patients, 21 had no metastasis 6 had lung metastasis, 18 preserved their fertility and conceived in the first year following the chemotherapy. Out of 3 patients who had developed invasive moles, 1 got pregnant after chemotherapy. Four of the patients with choriocarcinoma conceived in the first year following the chemotherapy. In the patient with placental site trophoblastic tumors, there was no pregnancy due to hysterectomy.
Conclusion: GTN was found to be a chemosensitive condition, but more effective therapeutic protocols are therefore required.
-Newlands ES, Paradinas FJ, Fisher RA.Recent advances in gestational trophoblastic disease.
Hematol Oncol Clin North Am. 1999 Feb; 13(1):225-44
-Seckl MJ, Sebire NJ, Berkowitz RS. Gestational trophoblastic disease. Lancet. 2010 Aug 28;376(9742):717-29. Epub 2010 Jul 29. doi: 10.1016/S0140-6736(10)60280-2.
-Bracken MB.Incidence and aetiology of hydatidiform mole: an epidemiological review. Br J Obstet Gynaecol. 1987 Dec; 94(12):1123-35.
-Palmer JR. Advances in the epidemiology of gestational trophoblastic disease. J Reprod Med. 1994 Mar;39(3):155-62.
-Mangili G, Lorusso D, Brown J, Pfisterer J, Massuger L, Vaughan M and et all. Trophoblastic disease review for diagnosis and management: a joint report from the International Society for the Study of Trophoblastic Disease, European Organisation for the Treatment of Trophoblastic Disease, and the Gynecologic Cancer InterGroup. Int J Gynecol Cancer. 2014 Nov;24(9 Suppl 3):S109-16. doi: 10.1097/IGC.0000000000000294.
- Schmid P, Nagai Y, Agarwal R, Hancock B, Savage PM, Sebire NJ and et all.Prognostic markers and long-term outcome of placental-site trophoblastic tumours: a retrospective observational study.Lancet. 2009 Jul 4;374(9683):48-55. doi: 10.1016/S0140-6736(09)60618-8. Epub 2009 Jun 22
- Harold Fox; Neil James Sebire. Pathology of the placenta (3rd end.) (2007).Elsevier, Philadelphia
-Baergen RN, Rutgers JL, Young RH, Osann K, Scully RE. Placental site trophoblastic tumor: A study of 55 cases and review of the literature emphasizing factors of prognostic significance. Gynecol Oncol. 2006 Mar; 100(3):511-20. Epub 2005 Oct 21.
-Sebire NJ, Fisher RA, Rees HC. Histopathological diagnosis of partial and complete hydatidiform mole in the first trimester of pregnancy. Pediatr Dev Pathol. 2003 Jan-Feb;6(1):69-77. Epub 2002 Dec 10.
- Shina Oranratanaphan, Ruangsak Lertkhachonsuk.Treatment of Extremely High Risk and Resistant Gestational Trophoblastic Neoplasia Patients in King Chulalongkorn Memorial Hospital. Asian Pacific Journal of Cancer Prevention, .2014; Vol 15
-Elit L, Covens A, Osborne R, Gerulath A, Murphy J, Rosen B, Sturgeon J. High-dose methotrexate for gestational trophoblastic disease. Gynecol Oncol. 1994 Sep;54(3):282-7
-Alazzam M, Tidy J, Hancock BW, Osborne R. First line chemotherapy in low risk gestational trophoblastic neoplasia. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD007102. doi: 10.1002/14651858.CD007102.pub2.
-Pongsaranantakul S, Kietpeerakool C.Hysterectomy in gestational trophoblastic neoplasia: Chiang Mai University Hospital's experience. Asian Pac J Cancer Prev. 2009 Apr-Jun;10(2):311-4.
- Berkowitz RS, Goldstein DP, Marean AR, Bernstein M. Oral contraceptives and post molar trophoblastic disease. Obstet Gynecol 1981; 58: 474-7.
-Curry SL, Schlaerth JB, Kohorn EI, Boyce JB, Gore H, Twiggs LB, Blessing JA.
Hormonal contraception and trophoblastic sequelae after hydatidiform mole (a Gynecologic Oncology Group Study) Am J Obstet Gynecol. 1989 Apr; 160(4):805-9; discussion 809-11.
- Deicas RE, Miller DS, Rademaker AW, Lurain JR, The role of contraception in the development of postmolar gestational trophoblastic tumor , Obstet Gynecol, 1991, 78(2):221–226.
-Alazzam M, Tidy J, Osborne R, Coleman R, Hancock BW, Lawrie TA.Chemotherapy for resistant or recurrent gestational trophoblastic neoplasia. Cochrane Database Syst Rev.2012; Dec 12;12:CD008891. doi: 10.1002/14651858.CD008891.pub2.
-Bower M, Newlands ES, Holden L, Short D, Brock C, Rustin GJ, Begent RH, Bagshawe KD. EMA/CO for high-risk gestational trophoblastic tumors: results from a cohort of 272 patients. J Clin Oncol. 1997 Jul;15(7):2636-43.
-Woolas RP, Bower M, Newlands ES, Seckl M, Short D, Holden L. Influence of chemotherapy for gestational trophoblastic disease on subsequent pregnancy outcome. Br J Obstet Gynaecol. 1998 Sep;105(9):1032-5.
- Matsui H, Iitsuka Y, Suzuka K, Yamazawa K, Tanaka N, Seki K, Sekiya S: Risk of abnormal pregnancy completing chemotherapy for gestational trophoblastic tumor. Gynecol Oncol 88(2):104-107, 2003.
-Rustin GJ, Booth M, Dent J, Salt S, Rustin F, Bagshawe KD.Pregnancy after cytotoxic chemotherapy for gestational trophoblastic tumours.Br Med J (Clin Res Ed). 1984 Jan 14;288(6411):103-6.
-Newlands ES, Bagshawe KD, Begent RH, Rustin GJ, Holden L.Results with the EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) regimen in high risk gestational trophoblastic tumours, 1979 to 1989. Br J Obstet Gynaecol. 1991 Jun;98(6):550-7.