title: The outcome of patients with low risk gestational trophoblastic neoplasia treated with single agent intramuscular methotrexate and oral folinic acid.
abstract: BACKGROUND
  Gestational trophoblastic neoplasia (GTN) persisting despite local treatment requires chemotherapy. In 2000, the revised International Federation of Gynaecology and Obstetrics (FIGO)/World Health Organisation (WHO) staging system was introduced, classifying patients as at 'low' or 'high' risk for resistance to single agent treatment.
  
  
  METHODS
  We have evaluated the complete response rates of patients with low risk GTN treated with 2 weekly intramuscular (IM) methotrexate 50mg four doses days 1, 3, 5, 7 and oral folinic acid 15 mg days 2, 4, 6, 8 (MTX/FA). Patient data between January 2000 and December 2011 were collated and the relationships between FIGO/WHO risk score and outcomes evaluated.
  
  
  RESULTS
  Two hundred and eighty nine patients were treated with single agent IM MTX/FA and assessed for treatment response. 29/36 (81%) patients with a FIGO/WHO total score of 6 developed resistance to MTX/FA compared with 87/253 (34%) patients with a score of 0-5 (p ≤ 0.0001). Significantly higher rates of resistance were found for patients with an hCG level of >100,000 iu/l compared to an hCG level of <100,000 iu/l (84% versus 34% p ≤ 0.0001). All patients were eventually cured with chemotherapy or surgical salvage.
  
  
  CONCLUSIONS
  Patients with low risk GTN that have a FIGO/WHO score of 6 or hCG level of >100,000 iu/l have high rates of resistance to MTX/FA and require further treatment. Revision of the FIGO/WHO scoring system may be appropriate to enable selection of more effective first line chemotherapy.
authors.affiliation: Sheffield Centre for Trophoblastic Disease, Weston Park Hospital, Cancer Research-UK/Yorkshire Cancer Research Sheffield Cancer Research Centre, Sheffield, UK. Electronic address: F.Taylor@sheffield.ac.uk.
authors.forename: F
authors.initials: F
authors.lastname: Taylor
authors.forename: T
authors.initials: T
authors.lastname: Grew
authors.forename: J
authors.initials: J
authors.lastname: Everard
authors.forename: L
authors.initials: L
authors.lastname: Ellis
authors.forename: M C
authors.initials: MC
authors.lastname: Winter
authors.forename: J
authors.initials: J
authors.lastname: Tidy
authors.forename: B W
authors.initials: BW
authors.lastname: Hancock
authors.forename: R E
authors.initials: RE
authors.lastname: Coleman
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007273:Injections, Intramuscular; D002955:Leucovorin / Q000008:administration & dosage / Q000009:adverse effects; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D002955:Leucovorin; D008727:Methotrexate
keywords: Chemotherapy; Gestational trophoblastic neoplasia; Low risk; Scoring system