Gestational trophoblastic neoplasia, management as per risk stratification in a developing country

 

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Abstract

Aims: The purpose of this analysis was to address the outcome of GTN from a tertiary care centre of India. Materials and Methods: We undertook a retrospective and prospective review of GTN cases treated at our centre from 2006 to 2014. Patients of GTN were assigned to low-risk or high-risk categories as per the FIGO scoring system. The low-risk group was treated with combination of actinomycin-D and methotrexate (MTX) and the high-risk group received the EMA/CO regimen. Salvage therapy was EP/TP. Treatment was continued for 3 cycles after normalization of β-hCG level, after which the patients were kept on follow-up. Results: In total, 52 GTN patients were treated at our institution during this period; 21 were low-risk and 31 were in the high-risk category. The lung was the most common site of metastasis. All low risk patients achieved complete remission. Among high risk patients one patient died while receiving first cycle chemotherapy, one patient relapsed and 29 patients achieved complete remission. The single relapsed patient also achieved remission with 2nd line chemotherapy. Conclusion: 1. Two drug combination of Actinomycin-D and Methotrexate is a better alternative to single drug chemotherapy especially in developing countries were proper risk stratification is not always possible. 2. Patients with high disease burden should initially be treated with low dose chemotherapy to avoid life threatening visceral haemorrhage.

Publication History

Article published online:
12 July 2021

© 2016. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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• References

• 1 Pisal N, Tidy J, Hancock B. Gestational trophoblastic disease: Is intensive follow up essential in all women? BJOG 2004;111:1449-51.
• 2 Sebire NJ, Foskett M, Short D, Savage P, Stewart W, Thomson M, et al. Shortened duration of human chorionic gonadotrophin surveillance following complete or partial hydatidiform mole: Evidence for revised protocol of a UK regional trophoblastic disease unit. BJOG 2007;114:760-2.
• 3 Seckl MJ, Fisher RA, Salerno G, Rees H, Paradinas FJ, Foskett M, et al. Choriocarcinoma and partial hydatidiform moles. Lancet 2000;356:36-9.
• 4 Costa HL, Doyle P. Influence of oral contraceptives in the development of post-molar trophoblastic neoplasia - A systematic review. Gynecol Oncol 2006;100:579-85.
• 5 Royal Colleges of Obstetricians and Gynecologists. Green-top Guideline No. 38 February, 2010.
• 6 Alici S, Eralp Y, Saip P, Argon A, Basaran M, Topuz E, et al. Clinical characteristics of gestational trophoblastic disease at a single institute. Tohoku J Exp Med 2002;197:95-100.
• 7 Sekharan PK, Sreedevi NS, Radhadevi VP, Beegam R, Raghavan J, Guhan B. Management of postmolar gestational trophoblastic disease with methotrexate and folinic acid: 15 years of experience. J Reprod Med 2006;51:835-40.
• 8 Khan F, Everard J, Ahmed S, Coleman RE, Aitken M, Hancock BW. Low-risk persistent gestational trophoblastic disease treated with low-dose methotrexate: Efficacy, acute and long-term effects. Br J Cancer 2003;89:2197-201.
• 9 McNeish IA, Strickland S, Holden L, Rustin GJ, Foskett M, Seckl MJ, et al. Low-risk persistent gestational trophoblastic disease: Outcome after initial treatment with low-dose methotrexate and folinic acid from 1992 to 2000. J Clin Oncol 2002;20:1838-44.
• 10 McGrath S, Short D, Harvey R, Schmid P, Savage PM, Seckl MJ. The management and outcome of women with post-hydatidiform mole ′low-risk′ gestational trophoblastic neoplasia, but hCG levels in excess of 100 000 IU l(-1). Br J Cancer 2010;102:810-4.
• 11 Gulia S, Bajpai J, Gupta S, Maheshwari A, Deodhar K, Kerkar RA, et al. Outcome of gestational trophoblastic neoplasia: Experience from a tertiary cancer centre in India. Clin Oncol (R Coll Radiol) 2014;26:39-44.
• 12 Bower M, Newlands ES, Holden L, Short D, Brock C, Rustin GJ, et al. EMA/CO for high-risk gestational trophoblastic tumors: Results from a cohort of 272 patients. J Clin Oncol 1997;15:2636-43.
• 13 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;98:550-7.
• 14 Newlands ES, Bower M, Holden L, Short D, Seckl MJ, Rustin GJ, et al. Management of resistant gestational trophoblastic tumors. J Reprod Med 1998;43:111-8.
• 15 Papadopoulos AJ, Foskett M, Seckl MJ, McNeish I, Paradinas FJ, Rees H, et al. Twenty-five years′ clinical experience with placental site trophoblastic tumors. J Reprod Med 2002;47:460-4.
• 16 Turan T, Karacay O, Tulunay G, Boran N, Koc S, Bozok S, et al. Results with EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) chemotherapy in gestational trophoblastic neoplasia. Int J Gynecol Cancer 2006;16:1432-8.