title: Results of treatment of patients with gestational trophoblastic neoplasia referred to the Brewer Trophoblastic Disease Center after failure of treatment elsewhere (1979-2006).
abstract: OBJECTIVE
  To review treatment results of patients with gestational trophoblastic neoplasia (GTN) whose care was transferred to the Brewer Trophoblastic Disease Center after failure of treatment elsewhere from 1979-2006.
  
  
  METHODS
  Twenty-seven (6.6%) of 408 patients with GTN treated at the Brewer Center from 1979-2006 had received unsuccessful treatment at other institutions prior to transfer to our center. Outcomes were analyzed and compared with 37 patients who received secondary therapy at the Brewer Center from 1962-1978.
  
  
  RESULTS
  Overall survival was 93% (25 of 27) in patients treated at the Brewer Center (1979-2006) after failed treatment elsewhere. The most common causes of treatment failure prompting referral to the Brewer Center were (1) use of a single-agent chemotherapy protocol to treat high-risk disease in 11 patients (41%), (2) inappropriate use of weekly methotrexate chemotherapy in 9 patients (33%), (3) failed sequential single-agent chemotherapy in 4 patients (15%), (4) use of the wrong multiagent chemotherapy for high-risk disease in 1 patient (4%) and (5) relapse from remission in 2 patients
  
  
  CONCLUSIONS
  Successful secondary treatment of GTN improved from 59% during 1962-1978 to 93% during 1979-2006 as a result of better chemotherapy protocols and experience treating the disease.
authors: John I. Brewer Trophoblastic Disease Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. jlurain@nmff.org
authors: John R
authors: JR
authors: Lurain
authors: Anna V
authors: AV
authors: Hoekstra
authors: Julian C
authors: JC
authors: Schink
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007044:Hysterectomy; D008727:Methotrexate / Q000627:therapeutic use*; D010360:Patient Transfer; D011247:Pregnancy; D012017:Referral and Consultation; D016019:Survival Analysis; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D008727:Methotrexate