The changing role of thoracotomy in gestational trophoblastic neoplasia at the New England Trophoblastic Disease Center.
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.
Fleming
Evelyn L
EL
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.
Garrett
Leslie
L
Growdon
Whitfield B
WB
Callahan
Michael
M
Nevadunsky
Nicole
N
Ghosh
Sue
S
Goldstein
Donald P
DP
Berkowitz
Ross S
RS
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