title: High-risk metastatic gestational trophoblastic disease.
abstract: The clinical course of 61 patients with high-risk metastatic gestational trophoblastic disease was reviewed. Currently, 34 patients (56%) are alive and in complete remission. The survival rate after full-term pregnancy was significantly worse than after any other type of antecedent pregnancy. Analyzing survival by individual high-risk criteria revealed significantly improved survival for those patients with elevated beta-human chorionic gonadotropin titer alone when compared with all other high-risk criteria. Fifty-eight percent of patients (14 of 24) primarily treated with alternating-sequential therapy consisting of methotrexate and actinomycin-D experienced a complete remission. Of those patients primarily treated with methotrexate, actinomycin-D, and cyclophosphamide, 63% (20 of 32) achieved a complete remission. Treatment with second-line chemotherapy was largely unsuccessful. Aggressive early treatment is warranted in this group of patients, using multiagent chemotherapy. A search for newer more effective regimens should continue.
authors.forename: A N
authors.initials: AN
authors.lastname: Gordon
authors.forename: D M
authors.initials: DM
authors.lastname: Gershenson
authors.forename: L J
authors.initials: LJ
authors.lastname: Copeland
authors.forename: P B
authors.initials: PB
authors.lastname: Saul
authors.forename: J J
authors.initials: JJ
authors.lastname: Kavanagh
authors.forename: C L
authors.initials: CL
authors.lastname: Edwards
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D006063:Chorionic Gonadotropin / Q000097:blood; D018997:Chorionic Gonadotropin, beta Subunit, Human; D003131:Combined Modality Therapy; D003609:Dactinomycin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D008175:Lung Neoplasms / Q000556:secondary; D008727:Methotrexate / Q000008:administration & dosage; D009362:Neoplasm Metastasis; D010446:Peptide Fragments / Q000097:blood; D011247:Pregnancy; D012189:Retrospective Studies; D012306:Risk; D014328:Trophoblastic Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D014594:Uterine Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology
chemical_list: D006063:Chorionic Gonadotropin; D018997:Chorionic Gonadotropin, beta Subunit, Human; D010446:Peptide Fragments; D003609:Dactinomycin; D008727:Methotrexate