Treatment of gestational trophoblastic tumors.
Gestational trophoblastic tumors (invasive mole, choriocarcinoma, and placental site trophoblastic tumor) should be classified according to the National Cancer Institute (NCI), World Health Organization (WHO), and International Federation of Gynecology and Obstetrics (FIGO) criteria into nonmetastatic, low-risk metastatic, and high-risk metastatic categories. Nonmetastatic tumors (FIGO Stage I) can be treated with a variety of single-agent methotrexate or actinomycin D protocols, resulting in cure of essentially all patients. Metastatic low-risk tumors (FIGO Stages II and III, WHO score < 8) should be treated with 5-day dosage schedules of methotrexate or actinomycin D, with cure rates approaching 100%. Metastatic high-risk tumors (FIGO Stage IV, WHO score > 7) require combination chemotherapy with etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMA-CO) with or without adjuvant radiation therapy and surgery to achieve cure rates of 80% to 90%.
Lurain
John R
JR
John I. Brewer Trophoblastic Disease Center, Department of Obstetrics and Gynecology, Northwestern University Medical School, Prentice Women's Hospital, 333 East Superior Street, Suite 420, Chicago, IL 60611, USA. jlurain@nmh.org
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage; D003609:Dactinomycin / Q000008:administration & dosage; D004334:Drug Administration Schedule; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D014328:Trophoblastic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D014750:Vincristine / Q000008:administration & dosage
D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D008727:Methotrexate