title: Etoposide, cisplatin-etoposide, methotrexate, actinomycin-D as primary treatment for management of very-high-risk gestational trophoblastic neoplasia.
abstract: OBJECTIVE
  To evaluate the efficacy of etoposide, cisplatin-etoposide, methotrexate, actinomycin-D (EP-EMA) chemotherapy as the frontline treatment for gestational trophoblastic neoplasia (GTN) patients with very high (≥ 12) FIGO prognostic scores.
  
  
  METHODS
  Nine patients with very-high-risk GTN were treated with EP-EMA at the Cancer Institute, Adyar, India, between January 1, 2001, and December 31, 2007. Salvage chemotherapy, adjuvant surgery, and radiotherapy were used when indicated. Clinical response, toxicity, and survival were analyzed separately.
  
  
  RESULTS
  The median FIGO score was 15. Six (66.7%) patients had a complete clinical response, whereas progressive disease occurred for 3 (33.3%) women. None of the patients relapsed. This translated to an overall survival rate of 66.7% in the primary setting. All patients with liver-only metastases were survivors after treatment with EP-EMA. Grade 3 neutropenia was detected in 3 (33.3%) patients only. No life-threatening toxicity was observed after EP-EMA treatment.
  
  
  CONCLUSIONS
  EP-EMA was highly effective for the primary management of very-high-risk GTN.
authors.affiliation: Department of Medical Oncology, Cancer Institute, Adyar, India. drsanpan80@yahoo.com
authors.forename: Sanju
authors.initials: S
authors.lastname: Cyriac
authors.forename: Rejiv
authors.initials: R
authors.lastname: Rajendranath
authors.forename: Veluswami
authors.initials: V
authors.lastname: Sridevi
authors.forename: Tenali G
authors.initials: TG
authors.lastname: Sagar
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D003609:Dactinomycin / Q000008:administration & dosage; D018450:Disease Progression; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000188:drug therapy* / Q000473:pathology / Q000628:therapy; D006801:Humans; D007194:India; D008113:Liver Neoplasms / Q000556:secondary; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D011247:Pregnancy; D012189:Retrospective Studies; D012306:Risk; D016879:Salvage Therapy / Q000379:methods; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003609:Dactinomycin; D005047:Etoposide; D002945:Cisplatin; D008727:Methotrexate