title: Twenty years' experience of treating gestational trophoblastic neoplasia in Sweden.
abstract: Experience gathered during the last 20 years in the treatment of gestational trophoblastic neoplasia (GTN) is presented. Fifty-eight cases were treated at the Karolinska Hospital during the period of 1966-86. This number accounts for approximately 50% of the cases in Sweden during this period of time. Thirty-four patients developed their malignancy after a molar pregnancy. Thirty-three patients were nonmetastatic and of the 25 metastatic cases, 6 patients were staged to a high-risk group. Chemotherapy was given to all patients except one who had a primary choriocarcinoma in an ectopic pregnancy. Surgery was performed in elective cases or when chemotherapy failed. Surgical procedures were also performed in a few emergency situations. Since 1978 all patients were started on methotrexate--folinic acid ad modum Goldstein. When this medication failed, either the CHAMOMA (vincristine, methotrexate--folinic acid, actinomycin D, melphalan, adriamycin) or later the EMA/CA (etoposide, methotrexate--folinic acid, actinomycin D, cyclophosphamide, adriamycin) regimen ad modum Bagshawe was given. An overall remission rate of 96.5% was achieved. The minimum period of follow-up was 2 years. The 2 patients who died (in 1966 and 1982) were referred to our department in a late stage. Five patients had a late recurrence and all but one were successfully treated.
authors.affiliation: Department of Obstetrics and Gynecology, Karolinska Sjukhuset, Stockholm, Sweden.
authors.forename: F
authors.initials: F
authors.lastname: Flam
authors.forename: V
authors.initials: V
authors.lastname: Lundström
mesh_terms: D000293:Adolescent; D000328:Adult; D003131:Combined Modality Therapy; D003609:Dactinomycin / Q000627:therapeutic use; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D009367:Neoplasm Staging; D011247:Pregnancy; D011379:Prognosis; D013548:Sweden; D014328:Trophoblastic Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D014594:Uterine Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*
chemical_list: D003609:Dactinomycin; D005492:Folic Acid; D008727:Methotrexate