title: Successful salvage therapy of resistant gestational trophoblastic disease with etoposide, methotrexate, actinomycin-D, etoposide, cisplatin (EMA/EP).
abstract: A 26-year-old woman who had been treated for nonmetastatic gestational trophoblastic tumor with three courses of methotrexate with folinic acid rescue and had been lost to follow up for 4 years was referred with the fractional curettage diagnosis of choriocarcinoma that had been performed for abnormal vaginal bleeding. Her serum beta human chorionic gonadotropin (betahCG) was 706000 mIU/mL and there were multiple pulmonary metastatic foci. The uterus was 12 weeks pregnant-size and a 6 x 6-cm tumor mass was seen within the anterior uterine wall at ultrasonography. Following total abdominal hysterectomy etoposide, methotrexate, actinomycin-D, vincristine and cyclophosphamide (EMA/CO) regimen was given. Whole brain radiation of 30 Gy in 3 weeks for brain metastasis, discovered in magnetic resonance imaging was given after the first course. Since serum betahCG levels plateaued after three courses of chemotherapy and multiple pulmonary metastases persisted, treatment was shifted to etoposide, methotrexate, actinomycin-D, etoposide, cisplatin (EMA/EP) regimen. She was in remission after three courses of chemotherapy.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Uludag University, Bursa, Turkey. tbilgin@uludag.edu.tr
authors.forename: Tufan
authors.initials: T
authors.lastname: Bilgin
authors.forename: Hakan
authors.initials: H
authors.lastname: Ozan
authors.forename: Sema
authors.initials: S
authors.lastname: Ozuysal
authors.forename: Lütfi
authors.initials: L
authors.lastname: Ozkan
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003609:Dactinomycin / Q000008:administration & dosage; D003937:Diagnosis, Differential; D019008:Drug Resistance, Neoplasm; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008727:Methotrexate / Q000008:administration & dosage; D011247:Pregnancy; D016879:Salvage Therapy; D014328:Trophoblastic Neoplasms / Q000175:diagnosis* / Q000556:secondary / Q000628:therapy; D014594:Uterine Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy
chemical_list: D003609:Dactinomycin; D005047:Etoposide; D002945:Cisplatin; D008727:Methotrexate