25 years' experience in the treatment of gestational trophoblastic neoplasia in Hungary.
OBJECTIVE
To review our clinical experience in the treatment of gestational trophoblastic neoplasia (GTN) over the past 25 years in our national trophoblastic disease center.


METHODS
Between January 1, 1977, and December 31, 2001, we treated 355 patients with GTN. The patients were between 14 and 53 years of age, with an average of 28.3. Primary chemotherapy was selected based on the patient's stage of gestational trophoblastic tumor (GTT) and prognostic score.


RESULTS
We found metastases in 49.3% (175 of 355) of our patients. Of 173 patients, 162 (93.2%) achieved remission as a result of methotrexate therapy. In 11 patients (6.8%) complete remission was achieved by combination chemotherapy, in some cases assisted by operation. Of 68 patients, 63 (92.6%) achieved remission as a result of actinomycin D therapy, and 5 (7.4%) achieved complete remission by combination chemotherapy. Chemotherapy, surgical intervention or other supplementary treatments resulted in 100% successful therapy in cases of nonmetastatic and low-risk metastatic disease.


CONCLUSIONS
According to our experience, methotrexate/folinic acid or actinomycin D should be the primary treatment in patients with nonmetastatic or low-risk metastatic GTN. Patients with resistance to single-agent chemotherapy regularly achieve remission with combination chemotherapy.
Szigetvári
Ivan
I
Department of Obstetrics and Gynecology, National Health Center, Budapest, Hungary.
Szepesi
János
J
Végh
György
G
Bátorfi
József
J
Arató
Gabriella
G
Gáti
István
I
Berkowitz
Ross S
RS
Fülöp
Vilmos
V
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology / Q000628:therapy; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D008499:Medical Records; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology / Q000628:therapy