title: Response to initial treatment of low and intermediate risk gestational trophoblastic disease with methotrexate and folinic acid.
abstract: OBJECTIVE
  To evaluate the response and toxicity of methotrexate and folinic acid given as primary treatment of low and intermediate risk gestational trophoblastic disease (GTD).
  
  
  METHODS
  Medical records review was performed in patients who received methotrexate and folinic acid as a primary treatment of low and intermediate risk persistent GTD between January 1992 and December 2001. Response was defined as decline of beta human chorionic gonadotropin (hCG) to < or = 5 mlU/ml (remission) after methotrexate and folinic acid treatment. Response rate was estimated and factors associated with response were evaluated.
  
  
  RESULTS
  Ninety four eligible patients were treated with intramuscular methotrexate and folinic acid. Complete remission was achieved in 64 cases (68%, 95% CI 58-78%). Mucositis (6.4%) and hepatotoxicity (6.4%) were the most common toxicity of methotrexate in the present study and none of these toxic effects was life threatening. Factors associated with response were initial serum hCG < or = 10,000 mlU/ml and stage I disease.
  
  
  CONCLUSIONS
  Methotrexate with folinic acid is effective treatment for low and intermediate risk GTD with minimal severe toxicity.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
authors.forename: Monnapa
authors.initials: M
authors.lastname: Tonanont
authors.forename: Peerapong
authors.initials: P
authors.lastname: Inthasorn
authors.forename: Dittakan
authors.initials: D
authors.lastname: Boriboonhirunsarn
authors.forename: Weerasak
authors.initials: W
authors.lastname: Wongthiraporn
authors.forename: Issaracha
authors.initials: I
authors.lastname: Suphanit
mesh_terms: D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D002955:Leucovorin / Q000009:adverse effects / Q000627:therapeutic use*; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use*; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome; D014803:Vitamin B Complex / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000964:Antimetabolites, Antineoplastic; D014803:Vitamin B Complex; D002955:Leucovorin; D008727:Methotrexate