Management of low-risk gestational trophoblastic neoplasia in indigent women.
OBJECTIVE
To identify the most effective dosing regimen for indigent patients with low-risk gestational trophoblastic neoplasia (GTN) at high risk of noncompliance.


METHODS
All women primarily treated for GTN at our public hospital between November 1990 and November 2001 were prospectively entered into a database. Patients were treated with either (1) methotrexate, 100 mg/m2, intravenous bolus, followed by a 12-hour infusion, 200 mg/m2 (regimen 1); (2) methotrexate, 0.4 mg/kg/m2 intramuscularly for 5 consecutive days on alternating weeks (regimen 2); or (3) methotrexate, 30-50 mg/m2 intramuscularly weekly (regimen 3). Medical records were reviewed to obtain clinical data, and statistical analysis was performed.


RESULTS
Thirty-two women were treated for low-risk GTN. The median age at diagnosis was 22 years (range, 15-40). Patients receiving regimen 1 (5/5, 100%) and 2 (19/20, 95%) were more likely to achieve complete remission without switching to dactinomycin or combination chemotherapy than those receiving regimen 3 (3/7, 43%; P < .001). Regimen 1 required fewer median treatment cycles (1.0, P = .04) than regimens 2 (6.5 cycles) and 3 (8.0 cycles). Seventeen (52%) patients were noncompliant with the chemotherapy protocol and/or posttreatment surveillance.


CONCLUSIONS
A 1-day methotrexate infusion is highly effective for treating indigent women with low-risk. GTN.
Schorge
John O
JO
Southwestern Trophoblastic Disease Center, Division of Gynecologic Oncology, Dep. of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, 75390-9032, USA. john.schorge@utsouthwestern.edu
Lea
Jayanthi S
JS
Farrar
Diana F
DF
King
Melanie R
MR
Coleman
Robert L
RL
Miller
David S
DS
D000293:Adolescent; D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage*; D002641:Chicago; D003695:Delivery of Health Care; D004334:Drug Administration Schedule; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000188:drug therapy*; D006801:Humans; D007262:Infusions, Intravenous; D007273:Injections, Intramuscular; D008499:Medical Records; D008727:Methotrexate / Q000008:administration & dosage*; D017063:Outcome Assessment, Health Care; D016896:Treatment Outcome; D017664:Uncompensated Care; D016387:Women's Health
D000903:Antibiotics, Antineoplastic; D008727:Methotrexate