title: Treatment for low-risk gestational trophoblastic disease: comparison of single-agent methotrexate, dactinomycin and combination regimens.
abstract: OBJECTIVE
  To compare the efficacy of three different standard chemotherapy regimens for low-risk gestational trophoblastic disease according to the FIGO staging system in a single-institute setting.
  
  
  METHODS
  From 1980 until 2002, we retrospectively reviewed 108 cases with low-risk persistent gestational trophoblastic disease who were treated with first-line chemotherapy. Patients were divided in three groups according to chemotherapy regimen: patients treated with methotrexate (MTX group; n=42), patients treated with dactinomycin (ACT group; n=42) and patients treated with methotrexate and dactinomycin in combination (MACT group; n=24). We compared the number of chemotherapy courses for achieving remission, the duration of treatment, the adverse side effects, the efficacy of the treatment and the need for performing a hysterectomy among the groups
  
  
  RESULTS
  The complete remission rates were 69%, 61.4% and 79.1% for methotrexate (MTX), dactinomycin (ACT) and the combination regimen (MACT) treated groups, respectively (p=0.7). The duration of the treatment and the number of chemotherapy courses were similar among the groups (p=0.2 and p=0.4, respectively). Adverse side effects rate was reported to be 62.5% in the MACT group, 28.6% in the MTX group and 19.1% in the ACT group (p=0.0003). Second-line chemotherapy was indicated for 30 patients. Hysterectomy was performed in 21 patients overall, and there was no difference among the groups (p=0.6).
  
  
  CONCLUSIONS
  Our analysis indicates that single-agent chemotherapy regimens are as effective as combination chemotherapy for low-risk gestational trophoblastic disease. Dactinomycin is a less toxic drug and might offer the best cost-effective treatment option. Methotrexate must be considered as the regimen of choice for low resource areas because of the feasibility of its administration.
authors.affiliation: Department of Gynecology and Obstetrics, Hospital das Clínicas of Ribeirão Preto School of Medicine, University of São Paulo, Ribeirao Preto, São Paulo, 14048-900, Brazil.
authors.forename: Renato Antonio
authors.initials: RA
authors.lastname: Abrão
authors.forename: Jurandyr Moreira
authors.initials: JM
authors.lastname: de Andrade
authors.forename: Daniel Guimarães
authors.initials: DG
authors.lastname: Tiezzi
authors.forename: Heitor Ricardo Cosiski
authors.initials: HR
authors.lastname: Marana
authors.forename: Francisco José
authors.initials: FJ
authors.lastname: Candido dos Reis
authors.forename: Willian Simões
authors.initials: WS
authors.lastname: Clagnan
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D003609:Dactinomycin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D009367:Neoplasm Staging; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D003609:Dactinomycin; D008727:Methotrexate