title: High-risk gestational trophoblastic neoplasia at Gujarat Cancer and Research Institute: thirteen years of experience.
abstract: OBJECTIVE
  To evaluate and analyze the results of chemotherapy (EMA-CO [etoposide, methotrexate, actinomycin D-cyclophosphamide, vincristine]) in high-risk gestational trophoblastic neoplasia (GTN).
  
  
  METHODS
  A total of 97 women with high-risk GTN were evaluated for a period of 13 years (1995-2008). All women received EMA-CO as a first-line chemotherapy. EMA-EP (etoposide, methotrexate, actinomycin and cisplatinum), PVB (cisplatin, vinblastine and bleomycin), and BEP (bleomycin, etoposide and cisplatin) were the chemotherapies used as second-line therapy in women who experienced resistance to primary chemotherapy. Intrathecal methotrexate was given in women with brain metastasis and also as prophylaxis in pulmonary metastasis. Eleven women had brain metastasis and received cranial radiotherapy. The most common toxicity was hematologic. .
  
  
  RESULTS
  Of 97 women, 78 (80.4%) were evaluable and 19 (19.6%) were lost to follow-up with incomplete treatment. Of the 78 patients, 6 women developed resistance and had progression of disease. Seven women had died (5 due to disease, 2 due to chemotherapy toxicity). Overall 65 of the 78 (83.3%) women achieved remission. Of the 78 women, 66.7% (52/78) had complete remission with first-line chemotherapy, and an additional 16.6% (13/78) achieved remission with second-line chemotherapy, resulting in a total of 83.3% (65/78) attaining remission. A total of 46% (30/ 65) had follow-up of > 3 years, and 32.4% (21/65) had follow-up of 1-3 years. Three of 9 women with brain metastasis achieved remission. Sixty percent (39/65) resumed normal menstrual function (had remission for at least 2 years). Twelve women became pregnant since the completion of the chemotherapy, with 10 live births of healthy infants without any congenital abnormalities.
  
  
  CONCLUSIONS
  High-risk GTNs are highly curable if properly treated, and patients can anticipate a normal future reproductive outcome. EMA-CO remains the preferred chemotherapy for management.
authors.affiliation: Gujarat Cancer and Research Institute, Regional Tertiary Cancer Center, B. J. Medical College Campus, Aswara, Ahmedabad, Gujarat, India. dranjuc@yahoo.com
authors.forename: Anjana
authors.initials: A
authors.lastname: Chauhan
authors.forename: Kalpana
authors.initials: K
authors.lastname: Dave
authors.forename: Ava
authors.initials: A
authors.lastname: Desai
authors.forename: Meeta
authors.initials: M
authors.lastname: Mankad
authors.forename: Shilpa
authors.initials: S
authors.lastname: Patel
authors.forename: Pariseema
authors.initials: P
authors.lastname: Dave
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001761:Bleomycin / Q000627:therapeutic use; D002945:Cisplatin / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D003609:Dactinomycin / Q000627:therapeutic use; D019008:Drug Resistance, Neoplasm; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D006801:Humans; D007194:India; D008727:Methotrexate / Q000627:therapeutic use; D009362:Neoplasm Metastasis; D011247:Pregnancy; D012074:Remission Induction; D012189:Retrospective Studies; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D014747:Vinblastine / Q000627:therapeutic use; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D001761:Bleomycin; D003609:Dactinomycin; D014750:Vincristine; D014747:Vinblastine; D005047:Etoposide; D003520:Cyclophosphamide; D002945:Cisplatin; D008727:Methotrexate