title: The WHO score predicts treatment outcome in low risk gestational trophoblastic neoplasia patients treated with weekly intramuscular methotrexate.
abstract: BACKGROUND
  Gestational trophoblastic neoplasia (GTN) includes a spectrum of disease ranging from hydatidifrom mole to choriocarcinoma. Low risk GTN is defined as persistent molar pregnancy with a WHO score lower than seven. The optimal chemotherapeutic regimen still remains controversial.
  
  
  OBJECTIVE
  The objectives of this study was to determine efficacy and safety of weekly intramuscular methotrexte in the treatment of low risk gestational trophoblastic neoplasia.(LRGTN) and also identify prognostic factors associated with treatment failure, necessitating second line chemotherapy.
  
  
  METHODS
  Sixty-six women with LRGTN from 2001 to 2009 were treated with weekly intramuscular methotrexate at 40 mg/m 2 as first line therapy.Monitoring of treatment was done with weekly checking of βhCG level. Three consecutive negative βhCG measurements showed complete response. After first negative βhCG measurement, one additional dose was administered for consolidation.
  
  
  RESULTS
  Of 66 patients, who started the treatment five continued their treatment in other medical centres and were excluded from final analysis for treatment evaluation, and seven discontinued first line therapy because of hepatotoxicity. Of the remaining 54, complete remission occurred in 43 (79.6%) and eleven were resistant to first line therapy. Mean WHO score prior to starting chemotherapy was significantly different between two groups of response and resistance according to our data. Change of treatment to second line Actinomycin-D was necessary in eighteen cases because of resistance to first line in eleven and liver enzyme elevation in seven patients. Sixteen of these 18 responded to Actinomycin-D as second line and one needed hysterectomy for complete response. One patient received multiagent chemotherapy for complete remission.
  
  
  CONCLUSIONS
  We recommend this effective and safe method of chemotherapy for women with LRGTN. According to our data, lower mean WHO score predicts a better outcome for this regimen.
authors.affiliation: Department of Gynecology and Oncology, Tehran University of Medical Sciences, Valie Asr Hospital, Tehran; Department of Gynecology, Beheshti Hospital, Motahari street, Isfahan, Iran.
authors.forename: Mitra M
authors.initials: MM
authors.lastname: Gilani
authors.forename: Behnamfar
authors.initials: B
authors.lastname: Fariba
authors.forename: Nadereh
authors.initials: N
authors.lastname: Behtash
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Ghaemmaghami
authors.forename: Azam S
authors.initials: AS
authors.lastname: Moosavi
authors.forename: Elahe
authors.initials: E
authors.lastname: Rezayof
mesh_terms: D000293:Adolescent; D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D019008:Drug Resistance, Neoplasm; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000188:drug therapy*; D006801:Humans; D007273:Injections, Intramuscular; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000964:Antimetabolites, Antineoplastic; D018997:Chorionic Gonadotropin, beta Subunit, Human; D008727:Methotrexate