title: Gestational trophoblastic disease with liver metastases: the Charing Cross experience.
abstract: OBJECTIVE
  To define management options for women presenting with gestational trophoblastic disease (GTD) which had already metastasised to the liver.
  
  
  METHODS
  Retrospective analysis of case records between 1958 and 1994.
  
  
  METHODS
  A national referral centre for trophoblastic disease.
  
  
  RESULTS
  The database containing 1676 treated patients was reviewed and 46 patients with hepatic metastases were identified (2.7%). The median age was 32 years (range 19-52 years). The antecedent pregnancy to the GTD was normal in 65% (30/46), and the time interval between the antecedent pregnancy and presentation was longer than one year in 50% (22/44). Lung metastases were present in 43 patients (93%) and brain deposits in 15 patients (33%). Forty-five patients (98%) were high risk by WHO criteria. The five-year overall survival was 27%. The five-year survival of the subgroup of patients having both hepatic and cerebral metastases was 10%. There was no significant survival difference between the different chemotherapy regimens used in the study period (pre-1979 CHAMOCA: methotrexate, actinomycin D, cyclophosphamide, doxorubicin, melphalan, hydroxyurea and vincristine; 1979 onwards EMA/CO-EP: etoposide, methotrexate, adriamycin-D/ cyclophosphamide, vincristine-etoposide and cis-platinum). Multivariate analysis revealed that a prognostic score > 12 was significant (Hazard ratio 5.4, 95% CI 0.7-41.9; P = 0.04).
  
  
  CONCLUSIONS
  The outcome for women presenting with hepatic metastases from GTD is poor with an even worse prognosis if cerebral metastases are also present. Alternative therapeutic measures, such as high dose therapy or new drugs, should be explored in these women.
authors.affiliation: St Bartholomew's Hospital, London, UK.
authors.forename: R A
authors.initials: RA
authors.lastname: Crawford
authors.forename: E
authors.initials: E
authors.lastname: Newlands
authors.forename: G J
authors.initials: GJ
authors.lastname: Rustin
authors.forename: L
authors.initials: L
authors.lastname: Holden
authors.forename: R
authors.initials: R
authors.lastname: A'Hern
authors.forename: K D
authors.initials: KD
authors.lastname: Bagshawe
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000556:secondary; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary*; D008175:Lung Neoplasms / Q000556:secondary; D008875:Middle Aged; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014328:Trophoblastic Neoplasms / Q000188:drug therapy*; D014594:Uterine Neoplasms / Q000188:drug therapy*