title: A comparison of patients with relapsed and chemo-refractory gestational trophoblastic neoplasia.
abstract: The majority of women requiring chemotherapy for gestational trophoblastic disease (GTN) are cured with their initial chemotherapy treatment. However, a small percentage either become refractory to treatment, or relapse after the completion of treatment. This study investigates the characteristics and outcome of these patients. Patients were identified from the Charing Cross Hospital GTD database. The outcome of these patients with relapsed disease was compared to those with refractory disease. Between 1980 and 2004, 1708 patients were treated with chemotherapy for GTN. Sixty (3.5%) patents relapsed following completion of initial therapy. The overall 5-year survival for patients with relapsed GTN was 93% (95% CI 86-100%). The overall survival for patients with low-risk and high-risk disease at presentation, who subsequently relapsed was 100% (n=35), and 84% (n=25) (95% CI: 66-96%: P<0.05), respectively. Eleven patients were identified who failed to enter remission and had refractory disease. These patients had a worse outcome compared to patients with relapsed disease (5-year survival 43% (95% CI:12-73% P<0.01)). The outcome of patients with relapsed GTN is good. However, patients with primary chemo-refractory disease do poorly and novel therapies are required for this group of patients.
authors.affiliation: Department of Medical Oncology, Charing Cross Gestational Trophoblastic Disease Centre, Hammersmith Hospitals Campus of Imperial College London, London, UK. thomas.powes@bartsandthelondon.nhs.uk
authors.forename: T
authors.initials: T
authors.lastname: Powles
authors.forename: P M
authors.initials: PM
authors.lastname: Savage
authors.forename: J
authors.initials: J
authors.lastname: Stebbing
authors.forename: D
authors.initials: D
authors.lastname: Short
authors.forename: A
authors.initials: A
authors.lastname: Young
authors.forename: M
authors.initials: M
authors.lastname: Bower
authors.forename: C
authors.initials: C
authors.lastname: Pappin
authors.forename: P
authors.initials: P
authors.lastname: Schmid
authors.forename: M J
authors.initials: MJ
authors.lastname: Seckl
mesh_terms: D017668:Age of Onset; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D006063:Chorionic Gonadotropin / Q000097:blood; D019008:Drug Resistance, Neoplasm; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000188:drug therapy*; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D011247:Pregnancy; D011379:Prognosis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006063:Chorionic Gonadotropin