Reduced systemic toxicity from superselective chemoembolization compared with systemic chemotherapy in patients with high-risk metastatic gestational trophoblastic disease.
OBJECTIVE
The efficacy of chemoembolization of primary and metastatic gestational trophoblastic neoplasms was studied.


METHODS
Six female patients, 19-33 years old, with high-risk trophoblastic disease were subjected to one to five chemoembolizations in 3-week intervals. Three of the patients had metastases to the liver, 2 had local tumor extension to the pelvic wall, and all 5 had failed initial systemic chemotherapy. The sixth patient was treated for a trophoblastic remnant following surgical expression of a tubal pregnancy. For follow-up, beta hCG levels in urine and serum and dynamic or angio-computed tomograms were obtained in biweekly to 6-month intervals.


RESULTS
Two of 3 patients with liver metastases are alive and free of disease 6 and 7 years after initial chemoembolization. The third is alive at 3 years but with evidence of recurrent disease. Two patients treated for locally invasive trophoblastic disease died 3 months and 4 years, respectively, after initial chemoembolization. One had a 2 1/2 -year remission. The patient treated for a trophoblastic remnant in the tube is alive and free of disease at 6-year follow-up. Hematologic toxicity occurred in only one.


CONCLUSIONS
Selective chemoembolization in our small series of patients with high-risk trophoblastic disease was equally effective as results reported for multi-drug systemic chemotherapy but had markedly lower renal, liver, and hematologic toxicity.
Lang
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Department of Radiology, L.S.U. Medical Center, 1542 Tulane Avenue, New Orleans, LA 70112, USA.
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects*; D004317:Doxorubicin / Q000009:adverse effects; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D008727:Methotrexate / Q000009:adverse effects; D009361:Neoplasm Invasiveness; D011247:Pregnancy; D011859:Radiography; D012307:Risk Factors; D014328:Trophoblastic Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000628:therapy*; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*
D004317:Doxorubicin; D008727:Methotrexate