30 years' experience in the treatment of low-risk gestational trophoblastic neoplasia in Hungary.
OBJECTIVE
To review the clinical experience in the treatment of patients with low-risk gestational trophoblastic neoplasia (GTN) over the past 30 years in a national trophoblastic disease center.


METHODS
Between January 1, 1977, and December 31, 2007, 302 patients with low-risk GTN were treated. The patients were directed to our institution from all parts of Hungary. The patients were 14 to 53 years of age with an average age of 28.3 years. Methotrexate (MTX)/folinic acid or actinomycin-D (Act-D) primary chemotherapy was selected based upon the patient's stage and prognostic score of GTN.


RESULTS
Among 218 low-risk patients, 210 (96.3%) achieved remission as a result of MTX therapy. In 8 patients (3.7%), MTX-Act-D-cyclophosphamide (MAC) combination chemotherapy was needed to achieve complete remission, in some cases assisted by operation. Among 84 patients, 81 (96.4%) achieved remission as a result of Act-D therapy. In 3 cases (3.6%) complete remission was achieved by MAC combination chemotherapy. We detected metastases in 22.8% (69/302) of our low-risk patients. Chemotherapy, surgical intervention or other supplementary treatments resulted in 100% remission in cases of low-risk nonmetastatic and metastatic disease.


CONCLUSIONS
Our data indicate that MTX/folinic acid or Act-D should be the primary treatment in patients with nonmetastatic or metastatic low-risk GTN. Importantly, patients with resistance to single-agent chemotherapy regularly achieve complete remission with MAC combination chemotherapy. Results show that patient care under the direction of experienced clinicians serves to optimize the opportunity for cure and minimize morbidity.
Fülöp
Vilmos
V
Department of Obstetrics and Gynecology, State Health Center, 111 Podmaniczky Street, Budapest, Hungary 1062. fulopvilmos@freemail.hu
Szigetvári
Ivan
I
Szepesi
János
J
Végh
György
G
Bátorfi
József
J
Nagymányoki
Zoltan
Z
Török
Miklos
M
Berkowitz
Ross S
RS
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000627:therapeutic use; D003609:Dactinomycin / Q000627:therapeutic use; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D006801:Humans; D006814:Hungary; D007044:Hysterectomy; D002955:Leucovorin / Q000008:administration & dosage; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D009367:Neoplasm Staging; D011247:Pregnancy; D012074:Remission Induction; D012189:Retrospective Studies; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D055815:Young Adult
D003609:Dactinomycin; D003520:Cyclophosphamide; D002955:Leucovorin; D008727:Methotrexate