[Combination chemotherapy with etoposide and cisplatin for high-risk, chemorefractory and recurrent gestational trophoblastic neoplasia].
OBJECTIVE
To evaluate the feasibility and effectiveness of combination chemotherapy with etoposide and cisplatin (EP) regimen on the patients with high-risk, chemorefractory and recurrent gestational trophoblastic neoplasia (GTN).


METHODS
Thirty-nine patients with gestational trophoblastic tumors were analyzed retrospectively, 25 of 39 patients were of high-risk, 9 patients were chemorefractory and 5 patients were recurrent. All 39 patients were administrated with EP regimen, and 10 patients were assisted with surgery. All the patients were followed up. Clinical response, toxicity, the occurrence of secondary tumors of all patients, and the fertility of 30 patients whose fertility function was preserved were investigated.


RESULTS
Thirty-nine GTN patients underwent a total of 221 cycles of the EP regimen. The average number of courses for each patient was 5.7. The total complete remission rate of the regimen was 74% (29/39). Twenty-five patients with high-risk GTN received a total of 139 cycles and the average number of courses was 5.6. Nineteen patients achieved complete remission and 6 patients showed drug-resistant. The complete remission rate of the high-risk group was 76% (19/25). Nine patients with chemorefractory GTN obtained a total of 55 cycles and the average number of courses was 6.1. Six patients achieved complete remission and 3 patients showed drug-resistant again. The complete remission rate of the chemorefractory group was 6/9. Five patients with recurrent GTN received 27 cycles and the average number of courses was 5.4. Four patients achieved complete remission, 1 patient showed drug-resistance and died. Bone marrow toxicity, gastrointestinal reaction and alopecia were the main side effects of the EP regimen, but the bone marrow toxicity was slight and no grade IV side effect occurred. No fatal effect was found. Eight of 30 patients whose fertility fuction was preserved had become pregnant after recovery, with a total of 8 pregnancies. Among them, 2 were terminated by induced abortion, and 6 underwent normal term delivery and gained 6 infants who had no congenital malformation. All the 6 children had normal growth and development after childbirth. None of the women developed secondary tumors.


CONCLUSIONS
The EP regimen is effective and safe for the treatment of high-risk, chemorefractory and recurrent GTN.
Jiang
Jie
J
Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan 250012, China.
Nan
Fang-Fang
FF
Yang
Xing-Sheng
XS
Zhang
You-Zhong
YZ
Wang
Bo
B
Kong
Bei-Hua
BH
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D006063:Chorionic Gonadotropin / Q000097:blood; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D019008:Drug Resistance, Neoplasm; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D031901:Gestational Trophoblastic Disease / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007970:Leukopenia / Q000139:chemically induced; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D009367:Neoplasm Staging; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D014839:Vomiting / Q000139:chemically induced; D055815:Young Adult
D006063:Chorionic Gonadotropin; D005047:Etoposide; D002945:Cisplatin