Assessment of the response to chemotherapy in gestational trophoblastic neoplasia with vaginal metastases.
OBJECTIVE
This study is designed to survey gestational trophoblastic neoplasia with vaginal metastases (GTN + VM) manifestations, prognosis and chemotherapy response in order to consider appropriate chemotherapy regimen for these patients. There have been just a few studies about treatment of GTN + VM.


METHODS
Patients with Stage III GTN with or without vaginal metastases who had referred to Vali-e-Asr Hospital during 1996-2006 have been selected to take part in this study and the size of metastases was measured. Then response and resistance to single and combination chemotherapy regimens have been compared in these two groups. The data were processed using SPSS system (release 10). Statistical analysis was done with Chi(2) to determine factors associated with complete clinical response. The level of significance was assigned at P< .05.


RESULTS
Forty-eight patients with stage III (with pulmonary metastases) GTN patients have been selected, 13 with vaginal metastases and 35 without vaginal metastases. Incidence of vaginal metastases in stage III was 26%. Metastases were mainly in distal part of vagina and suburethra. Chief complaint was severe hemorrhage in 25% of patients and was controlled by vaginal packing with just one exception. Group of vaginal metastases showed 66.6% resistance to first-line chemotherapy, compared to 28.6% in patients with no vaginal metastases (P-value=0.010). Median of chemotherapy courses in low-risk vaginal metastatic patients was 5 (mean=5.2), compared to three courses in the group without vaginal metastases. Resistance to single chemotherapy was significantly higher in GTN + VM versus GTN without VM patients and resistance was higher especially in patients with metastases with more than 3 cm (in diameter).


CONCLUSIONS
Vaginal metastasis with more than 3 cm in diameter is an important prognostic factor in GTN patients. There have higher risks for severe hemorrhage and resistance to single agent chemotherapy, so in these patients combination chemotherapy, with no regard to staging and scoring, would be a better choice.
Ghaemmaghami
Fatemeh
F
Gynecology Oncology Department, Tehran University of Medical Sciences, Tehran, Iran. ftghaemmagh@yahoo.com
Fatemeh
Ghaemmaghami
G
Behroozi
Shohreh
S
Shohreh
Behroozi
B
Mousavi
Azamolsadat
A
Azamolsadat
Mousavi
M
Ashrafgangooei
Tahereh
T
Tahereh
Ashrafgangooei
A
Gilani
Mitra Modares
MM
Mitra
Modares Gilani
MG
Behtash
Nadereh
N
Nadereh
Behtash
B
Ghanbari
Zinat
Z
Zinat
Ghanbari
G
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D015331:Cohort Studies; D003520:Cyclophosphamide / Q000627:therapeutic use; D003609:Dactinomycin / Q000627:therapeutic use; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D009367:Neoplasm Staging; D011247:Pregnancy; D012189:Retrospective Studies; D016019:Survival Analysis; D014625:Vaginal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000556:secondary; D014750:Vincristine / Q000627:therapeutic use; D055815:Young Adult
D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D008727:Methotrexate