title: Combination chemotherapy with 5-fluorouracil, methotrexate and etoposide for patients with high-risk gestational trophoblastic tumors: a report based on our 11-year clinical experiences.
abstract: OBJECTIVE
  To evaluate the efficacy, toxicity, and survival of patients with high-risk gestational trophoblastic tumors (GTTs) treated with the 5-fluorouracil (5-FU), methotrexate (MTX) and etoposide (VP-16) regimen.
  
  
  METHODS
  Between 1992 and 2003, 26 consecutive patients with FIGO-defined high-risk GTTs were treated with 5-FU, MTX and VP-16 regimen. Among them, 9 patients had received prior chemotherapy. Remission rate, causes of treatment failure, and toxicity were analyzed retrospectively.
  
  
  RESULTS
  After treatment with 5-FU, MTX and VP-16 regimen, 21 of 26 gained complete respond (80.8%). Two patients were performed adjuvant hysterectomy and both cured ultimately. Five developed resistance (19.2%), and 1 died of widespread metastases (3.8%). All 5 patients who developed resistance were treated with multidrug regimen of etoposide, methotrexate, and actionmycin D alternating with cyclophosphamide and vincristine (the EMA/CO); 4 were salvaged and 1 died of refractory disease. No ones relapsed. WHO grade 4 leukocytopenia and thrombocytopenia with the 5-FU, MTX and VP-16 regimen occurred in 9.0% and 2.4%, respectively, of the total 167 cycles; other toxic effects were acceptable and manageable. With mean follow up of 37 months, neither relapse nor secondary tumor was observed.
  
  
  CONCLUSIONS
  According to our 11 years of clinical observation, 5-FU, MTX and VP-16 chemotherapy is one of effective multiagent regimen for patients with high-risk GTTs. Its toxicity is mild and manageable. For patients with high-risk and refractory GTTs, this new triple salvage chemotherapy regimen may be an effective alternative.
authors.affiliation: Department of Gynecology and Obstetrics, First Hospital, Medical College, Xi'an Jiaotong University, 1 Jiankang Road, Xi'an, Shaanxi 710061, PR China. wangshu@mail.xjtu.edu.cn
authors.forename: Shu
authors.initials: S
authors.lastname: Wang
authors.forename: Ruifang
authors.initials: R
authors.lastname: An
authors.forename: Xiaobing
authors.initials: X
authors.lastname: Han
authors.forename: Kexiu
authors.initials: K
authors.lastname: Zhu
authors.forename: Yan
authors.initials: Y
authors.lastname: Xue
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002681:China; D019008:Drug Resistance, Neoplasm; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D016019:Survival Analysis; D016896:Treatment Outcome; D014328:Trophoblastic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology
chemical_list: D005047:Etoposide; D005472:Fluorouracil; D008727:Methotrexate