title: The management and outcome of women with post-hydatidiform mole 'low-risk' gestational trophoblastic neoplasia, but hCG levels in excess of 100 000 IU l(-1).
abstract: BACKGROUND
  Gestational trophoblastic neoplasia (GTN) after a hydatidiform mole is either treated with single- or multi-agent chemotherapy determined by a multifactorial scoring system. Women with human chorionic gonadotrophin (hCG) levels >100 000 IU l(-1) can remain within the low-risk/single-agent category and usually choose one drug therapy. Here we compare the success and duration of single- vs multi-agent chemotherapy in this patient group.
  
  
  METHODS
  Between 1980 and 2008, 65 women had a pre-treatment hCG >100 000 IU l(-1) and were low risk. The initial hCG level, treatment regimens, changes and duration and overall survival were recorded.
  
  
  RESULTS
  Of 37 patients starting low-risk/single-agent treatment, 11 (29.7%) were treated successfully, whereas 26 (70.3%) required additional multi-agent chemotherapy to achieve complete remission (CR). Combination chemotherapy was initially commenced in 28 women, and 2 (7%) required additional drugs for CR. The overall duration of therapy for those commencing and completing single- or multi-agent chemotherapy was 130 and 123 days (P=0.78), respectively. The median-treatment duration for patients commencing single-agent but changing to multi-agent chemotherapy was 13 days more than those receiving high-risk treatment alone (136 vs 123 days; P=0.07). All 3 patients with an initial hCG >400 000 IU l(-1) and treated with single-agent therapy developed drug resistance. Overall survival for all patients was 100%.
  
  
  CONCLUSIONS
  Low-risk post-molar GTN patients with a pre-treatment hCG >100 000 and <400 000 IU l(-1) can be offered low-risk single-agent therapy, as this will cure 30%, is relatively non-toxic and only prolongs treatment by 2 weeks if a change to combination agents is required. Patients whose hCG is >400 000 IU l(-1) should receive multi-agent chemotherapy from the outset.
authors.affiliation: Department Medical Oncology, Charing Cross Hospital Trophoblastic Disease Screening and Treatment Centre, Imperial College NHS Healthcare Trust, Fulham Palace Road, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: McGrath
authors.forename: D
authors.initials: D
authors.lastname: Short
authors.forename: R
authors.initials: R
authors.lastname: Harvey
authors.forename: P
authors.initials: P
authors.lastname: Schmid
authors.forename: P M
authors.initials: PM
authors.lastname: Savage
authors.forename: M J
authors.initials: MJ
authors.lastname: Seckl
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D006063:Chorionic Gonadotropin / Q000097:blood*; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D009367:Neoplasm Staging; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D006063:Chorionic Gonadotropin