Management of gestational trophoblastic neoplasia with 5-fluorouracil and actinomycin D in northern China.
OBJECTIVE
To study risk factors associated with the number of chemotherapy courses required to obtain normal beta-human chorionic gonadotropin (beta-hCG) levels and evaluate the effectiveness of combination chemotherapy using 5-fluorouracil (5-FU) and actinomycin D (Act D) (FA) for gestational trophoblastic neoplasia (GTN).


METHODS
A retrospective study of GTN cases from January 1995 to July 2007 at the Beijing Obstetrics and Gynecology Hospital was performed.


RESULTS
During the study period, 240 cases of GTN were diagnosed and managed at our institution. A stepwise regression analysis revealed that the interval between evacuation and chemotherapy, parity, age and beta-hCG level were associated with number of chemotherapy courses required to obtain normal beta-hCG levels. In addition to 4 patients with placental site trophoblastic tumor, FA was used in 218 patients (136 low risk and 82 high risk).


CONCLUSIONS
Early detection of GTN and timely administration of chemotherapy decreases the number of chemotherapy courses required. The combination chemotherapy of 5-FU and Act D is effective in low- and high-risk patients with GTN, but not in patients with placental site trophoblastic tumor; it can be used as primary chemotherapy regimen in high-risk patients with GTN, except those with extensive metastases.
Zhao
Ying
Y
Division of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People's Republic of China.
Zhang
Weiyuan
W
Duan
Wei
W
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002681:China; D015331:Cohort Studies; D003609:Dactinomycin / Q000008:administration & dosage*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage*; D006801:Humans; D006828:Hydatidiform Mole / Q000188:drug therapy* / Q000473:pathology; D009367:Neoplasm Staging; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome; D018245:Trophoblastic Tumor, Placental Site / Q000188:drug therapy* / Q000473:pathology; D055815:Young Adult
D003609:Dactinomycin; D005472:Fluorouracil