Journal Article

The roles of surgery and EMA/CO chemotherapy regimen in primary refractory and non-refractory gestational trophoblastic neoplasia

İlhan, Huseyin Ridvan, Tas, Faruk, Aydiner, Adnan, Bengisu, Ergin, Berkman, Sinan, Topuz, Erkan, Keskin, Serkan

2012

Overview

Purpose To determine the characteristics and outcome of patients with refractory gestational trophoblastic neoplasia (GTN) after primary chemotherapy (CTx). Methods The outcome of low- and high-risk patients with refractory GTN ( n  = 14, 37%) was compared to those with non-refractory GTN ( n  = 24, 63%). Methotrexate treatment was used for patients with low-risk disease and EMA/CO for patients with high-risk disease. Results Median follow-up time was 53 months (range 1–173 months). All non-refractory patients and 11 refractory patients (79%) survived ( p  = 0.015). Factors related to resistance to primary CTx was age ( p  = 0.012), duration between causal pregnancy and initial treatment ( p  = 0.003), surgery ( p  = 0.014), hCG level before CTx ( p  = 0.09) and half-life of hCG ( p  = 0.061). Six out of 10 low-risk refractory patients treated with EMA/CO regimen in the second-line setting had been followed by no evidence of disease. Nine of 38 (24%) patients underwent surgery (TAH ± BSO) for GTN. All of the patients treated with surgery were in the non-refractory group, but none of refractory patients underwent surgery ( p  = 0.014). Conclusions Surgery and EMA/CO regimen are one of the main factors that play a role in the management of refractory low-risk GTN.

• Publisher: Springer Berlin Heidelberg,Springer,Springer Nature B.V
• Subject: Adult / Antineoplastic agents / Antineoplastic Combined Chemotherapy Protocols - administration & dosage / Antineoplastic Combined Chemotherapy Protocols - therapeutic use / Biological and medical sciences / Cancer Research / Chemotherapy / Chorionic Gonadotropin - blood / Cyclophosphamide - administration & dosage / Dactinomycin - administration & dosage / Diseases of mother, fetus and pregnancy / drug therapy / Etoposide - administration & dosage / Female / Follow-Up Studies / Gestational Trophoblastic Disease - blood / Gestational Trophoblastic Disease - drug therapy / Gestational Trophoblastic Disease - surgery / Gynecology. Andrology. Obstetrics / Half-Life / Hematology / Humans / Internal Medicine / Medical sciences / Medicine / Medicine & Public Health / Methotrexate / Methotrexate - administration & dosage / Methotrexate - therapeutic use / Middle Aged / neoplasms / Oncology / Original Paper / Patients / Pharmacology. Drug treatments / Pregnancy / Pregnancy. Fetus. Placenta / Reproductive system / Retrospective Studies / Risk groups / Surgery / Tumors / Uterine Neoplasms - blood / Uterine Neoplasms - drug therapy / Uterine Neoplasms - surgery / Vincristine - administration & dosage / Women / Young Adult