title: Metastatic gestational trophoblastic disease: experience at the New England Trophoblastic Disease Center, 1965 to 1985.
abstract: This report reviews the results of therapy in 93 patients with metastatic gestational trophoblastic tumor treated from 1965-1985. Complete remission was achieved in all 42 patients with low-risk metastatic disease and in 34 of 51 patients (67%) with high-risk metastatic disease. Single-agent chemotherapy induced complete remission in 38 of 42 patients (91%) with low-risk metastatic disease. Survival of high-risk patients has improved markedly over the past two decades; complete remission was attained in 13 of 24 high-risk patients (54%) from 1965-1975, and in 21 of 27 (78%) from 1976-1985. Survival correlated with the number of high-risk factors, the prognostic score, and the type of treatment. From 1965-1975, 54% (13 of 24) of high-risk patients were treated with single-agent chemotherapy alone, while in the last decade only 7% (two of 27) were so treated. Twenty-one patients with traditional high-risk factors had a prognostic score of 7 or less, and all achieved remission, with 67% (14 of 21) treated with primary single-agent chemotherapy. The prognostic scoring system was more effective than traditional high-risk criteria at predicting which patients require intensive combination chemotherapy to attain remission.
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D006063:Chorionic Gonadotropin / Q000032:analysis; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007044:Hysterectomy; D011247:Pregnancy; D011379:Prognosis; D011882:Radiotherapy, High-Energy; D012074:Remission Induction; D012306:Risk; D014328:Trophoblastic Neoplasms / Q000556:secondary / Q000628:therapy*; D014594:Uterine Neoplasms / Q000628:therapy*
chemical_list: D006063:Chorionic Gonadotropin