Management of high-risk hydatidiform mole and persistent gestational trophoblastic neoplasia: the Korean experience.
OBJECTIVE
To test the efficacy of a new scoring system to differentiate high-risk hydatidiform mole (H-mole) and initiate early selective postmolar chemotherapy.


METHODS
According to Kim's scoring system, 262 patients were identified as high-risk H-mole patients. Fifty (19.1%) received early chemotherapy, and the rest constituted the control group. Salvage therapy with etoposide, methotrexate, actinomycin D/etoposide, cisplatin (EMA/EP) and taxol, cisplatin/taxol, etoposide (TP/TE) was applied in 21 cases of ultra-high-risk GTT.


RESULTS
None of the 50 cases in the early chemotherapy group progressed to persistent GTT. However, 58.9% in the control group developed GTT with 8.0% drug resistance. Of those receiving salvage therapy in the 21 ultra-high-risk GTT cases resistant to EMA/CO, 10 of 14 (71%) receiving EMA/EP and 4 of 7 (57.1%) receiving TP/TE achieved remission.


CONCLUSIONS
Early postmolar chemotherapy for high-risk H-mole is effective in preventing progression to persistent GTT and treatment failure. Ultra-high-risk GTT should be approached with multimodal treatment, including EMA/EP and TP/TE regimens.
Kim
Seung Jo
SJ
Comprehensive Gynecologic Cancer Center, Pochon CHA University School of Medicine, Gyonggi-do, Seoul, South Korea. sjkim@cha.ac.kr
Na
Young Jeong
YJ
Jung
Sang Geun
SG
Kim
Chan Joo
CJ
Bae
Seog Nyeon
SN
Lee
Chan
C
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016022:Case-Control Studies; D002945:Cisplatin / Q000008:administration & dosage; D003609:Dactinomycin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006828:Hydatidiform Mole / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D007723:Korea; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000517:prevention & control*; D017239:Paclitaxel / Q000008:administration & dosage; D011247:Pregnancy; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy; D012720:Severity of Illness Index; D014594:Uterine Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000601:surgery
D003609:Dactinomycin; D005047:Etoposide; D017239:Paclitaxel; D002945:Cisplatin; D008727:Methotrexate