title: The changing role of thoracotomy in gestational trophoblastic neoplasia at the New England Trophoblastic Disease Center.
abstract: OBJECTIVE
  To review our experience with thoracotomy in gestational trophoblastic neoplasia (GTN).
  
  
  METHODS
  Nineteen thoracotomy patients from our database were identified. Thoracotomy was performed for therapeutic reasons in 11 patients and to clarify the diagnosis in eight.
  
  
  RESULTS
  Among the 11 patients with chemotherapy-resistant pulmonary tumors, 10 of 11 (90.9%) achieved remission with thoracotomy. Thoracotomy was more likely to be done to clarify diagnosis before 1980 (83%) than after 1980 (23%) (p = 0.04), when it became more likely to be done for therapeutic indications. Ten patients had solitary lung lesions and 9 had multiple lesions. Four patients died (21%), with an average survival after thoracotomy of 149 days; patients had bilateral or multiple lung lesions, median preoperative hCG was 58,000 mIU/mL and all were stage IV. Survivors had lower stage disease, were more likely to have solitary lesions and had lower preoperative hCG levels.
  
  
  CONCLUSIONS
  There have been several temporal changes in the indications for thoracotomy for GTN. In general, the optimal patient to achieve remission with thoracotomy will have stage III disease, a preoperative hCG of < 1,500 mIU/mL, and a solitary lung nodule resistant to chemotherapy. Likelihood of remission after thoracotomy is high in properly selected patients.
authors: Division of Gynecologic Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, New England Trophoblastic Disease Center, Donald P Goldstein, MD., 75 Francis Street, Boston, MA 02115, USA.
authors: Evelyn L
authors: EL
authors: Fleming
authors: Leslie
authors: L
authors: Garrett
authors: Whitfield B
authors: WB
authors: Growdon
authors: Michael
authors: M
authors: Callahan
authors: Nicole
authors: N
authors: Nevadunsky
authors: Sue
authors: S
authors: Ghosh
authors: Donald P
authors: DP
authors: Goldstein
authors: Ross S
authors: RS
authors: Berkowitz
mesh_terms: D000328:Adult; D002822:Choriocarcinoma / Q000556:secondary / Q000601:surgery*; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000601:surgery*; D006801:Humans; D008175:Lung Neoplasms / Q000556:secondary / Q000601:surgery*; D011247:Pregnancy; D013908:Thoracotomy; D014594:Uterine Neoplasms / Q000473:pathology*; D055815:Young Adult