title: Diagnosis and treatment of high-risk metastatic gestational trophoblastic neoplasia in Hungary.
abstract: OBJECTIVE
  To review results in treatment of high-risk metastatic gestational trophoblastic neoplasia (GTN) in Hungary.
  
  
  METHODS
  Between January 1, 1977, and December 31, 2006, 142 patients with high-risk metastatic GTN were treated. Patients were 14-51 years of age (average 27.9). We selected primary chemotherapy based on patient GTN stage and prognostic score.
  
  
  RESULTS
  Methotrexate, actinomycin-D and cyclophosphamide (MAC) as a primary therapy was used in 100 cases and as second-line chemotherapy in 6 cases. Of the 100 cases, 95 achieved complete remission. Twenty-one high-risk patients were treated with etoposide, high-dose methotrexate with folinic acid rescue, actinomycin-D, cyclophosphamide and vincristine (EMA-CO). Of 17 primary therapies, 13 patients achieved complete remission. Primary cisplatin, etoposide and bleomycin (CEB) was successful in 12 of 14 high-risk cases. Hysterectomy was performed in 42 of 142 high-risk patients; metastases were resected in 26 of 142 of high-risk patients. Comparison of mean prognostic scores resulted in significant differences between CEB and MAC, CEB and EMA-CO and MAC and EMA-CO.
  
  
  CONCLUSIONS
  Results support that patients with high-risk metastatic GTN should primarily be treated with combination chemotherapy. Our data support the effectiveness of MAC, EMA-CO and CEB regimens.
authors: Department of Obstetrics and Gynecology, State Health Center and Gyula Nyírö Hospital, Budapest, Hungary. fulopvilmos@freemail.hu
authors: Vilmos
authors: V
authors: Fülöp
authors: Iván
authors: I
authors: Szigetvŕi
authors: János
authors: J
authors: Szepesi
authors: Miklós
authors: M
authors: Török
authors: Ross S
authors: RS
authors: Berkowitz
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000627:therapeutic use; D016190:Carboplatin / Q000627:therapeutic use; D002945:Cisplatin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000627:therapeutic use; D003609:Dactinomycin / Q000627:therapeutic use; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D006814:Hungary; D007044:Hysterectomy; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011247:Pregnancy; D012307:Risk Factors; D014750:Vincristine / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D001761:Bleomycin; D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D016190:Carboplatin; D002945:Cisplatin; D008727:Methotrexate