title: The roles of surgery and EMA/CO chemotherapy regimen in primary refractory and non-refractory gestational trophoblastic neoplasia.
abstract: OBJECTIVE
  To determine the characteristics and outcome of patients with refractory gestational trophoblastic neoplasia (GTN) after primary chemotherapy (CTx).
  
  
  METHODS
  The outcome of low- and high-risk patients with refractory GTN (n = 14, 37%) was compared to those with non-refractory GTN (n = 24, 63%). Methotrexate treatment was used for patients with low-risk disease and EMA/CO for patients with high-risk disease.
  
  
  RESULTS
  Median follow-up time was 53 months (range 1-173 months). All non-refractory patients and 11 refractory patients (79%) survived (p = 0.015). Factors related to resistance to primary CTx was age (p = 0.012), duration between causal pregnancy and initial treatment (p = 0.003), surgery (p = 0.014), hCG level before CTx (p = 0.09) and half-life of hCG (p = 0.061). Six out of 10 low-risk refractory patients treated with EMA/CO regimen in the second-line setting had been followed by no evidence of disease. Nine of 38 (24%) patients underwent surgery (TAH ± BSO) for GTN. All of the patients treated with surgery were in the non-refractory group, but none of refractory patients underwent surgery (p = 0.014).
  
  
  CONCLUSIONS
  Surgery and EMA/CO regimen are one of the main factors that play a role in the management of refractory low-risk GTN.
authors.affiliation: Department of Medical Oncology, Oncology Institute, Istanbul University, Capa, 34093 Istanbul, Turkey.
authors.forename: Adnan
authors.initials: A
authors.lastname: Aydiner
authors.forename: Serkan
authors.initials: S
authors.lastname: Keskin
authors.forename: Sinan
authors.initials: S
authors.lastname: Berkman
authors.forename: Ergin
authors.initials: E
authors.lastname: Bengisu
authors.forename: Huseyin Ridvan
authors.initials: HR
authors.lastname: Ilhan
authors.forename: Faruk
authors.initials: F
authors.lastname: Tas
authors.forename: Erkan
authors.initials: E
authors.lastname: Topuz
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D006063:Chorionic Gonadotropin / Q000097:blood; D003520:Cyclophosphamide / Q000008:administration & dosage; D003609:Dactinomycin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D031901:Gestational Trophoblastic Disease / Q000097:blood / Q000188:drug therapy* / Q000601:surgery*; D006207:Half-Life; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D011247:Pregnancy; D012189:Retrospective Studies; D014594:Uterine Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000601:surgery*; D014750:Vincristine / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D006063:Chorionic Gonadotropin; D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D008727:Methotrexate