High-risk metastatic gestational trophoblastic tumors. Current management.
Aggressive multimodality therapy with an appropriate combination of chemotherapy and adjuvant radiotherapy and surgery has resulted in a cure for most patients with high-risk, metastatic gestational trophoblastic tumors. The EMA-CO chemotherapy regimen, employing etoposide, high-dose methotrexate, actinomycin D, cyclophosphamide and vincristine, is highly effective and well tolerated. Complete response rates of 80-94% and survival rates of 82-100% have been reported. For patients with central nervous system metastases, whole brain irradiation is given simultaneously with the initiation of combination chemotherapy employing a high-dose methotrexate infusion. Surgical procedures, especially hysterectomy and thoracotomy, may be useful for the purpose of removing known foci of chemotherapy-resistant disease. Subsequent salvage chemotherapy with cisplatin and bleomycin in combination with etoposide will result in a cure for almost all patients. The factors that are most important in determining response to treatment in patients with metastatic, high-risk disease are metastases to sites other than the lung and vagina, more than eight metastases, previous failed chemotherapy and a World Health Organization score > or = 8.
Lurain
J R
JR
Department of Obstetrics and Gynecology, Northwestern University Medical School, Chicago, Illinois 60611.
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D001932:Brain Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000556:secondary* / Q000628:therapy*; D002985:Clinical Protocols; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D003520:Cyclophosphamide / Q000008:administration & dosage; D003609:Dactinomycin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008175:Lung Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000556:secondary* / Q000628:therapy*; D008727:Methotrexate / Q000008:administration & dosage; D009367:Neoplasm Staging; D011247:Pregnancy; D011379:Prognosis; D012074:Remission Induction; D012307:Risk Factors; D015996:Survival Rate; D013908:Thoracotomy; D016896:Treatment Outcome; D014328:Trophoblastic Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000556:secondary* / Q000628:therapy*; D014594:Uterine Neoplasms / Q000473:pathology*; D014625:Vaginal Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000556:secondary* / Q000628:therapy*; D014750:Vincristine / Q000008:administration & dosage
D001761:Bleomycin; D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D008727:Methotrexate