Outcome of gestational trophoblastic neoplasia: experience from a tertiary cancer centre in India.
OBJECTIVE
Gestational trophoblastic neoplasms (GTN) comprise a spectrum of interrelated conditions originating from the placenta. With sensitive assays for human chorionic gonadotropin (β-hCG) and current approaches to chemotherapy, most women with GTN can be cured with preservation of reproductive potential. The purpose of this analysis was to address the outcome of GTN from a developing country, as data are largely sparse from this region.


METHODS
We undertook a retrospective review of GTN cases treated at our centre from 2001 to 2008. Patients of GTN were assigned to low-risk (score ≤ 6) or high-risk (score ≥ 7) categories as per the modified World Health Organization scoring system. The low-risk group was treated with single-agent methotrexate (MTX) and the high-risk group received the EMA/CO regimen. Salvage therapies were EMA/EP or BEP. Treatment was continued until serum β-hCG values were normal for three consecutive chemotherapy cycles, after which the patients were kept on follow-up.


RESULTS
In total, 70 GTN patients were treated at our institution during this period; 48 (68%) were low-risk and 22 (32%) were in the high-risk category. The median β-hCG level was 50 000 IU/l. The lung was the most common site of metastasis, seen in 15 (21%) patients. Among 48 low-risk patients, 37 (77%) received chemotherapy, of whom 25 (68%) were treated with MTX and 24 (96%) achieved a complete response. Twelve low-risk patients (32%) received EMA/CO therapy; 10 (83%) achieved a complete response. The 22 high-risk patients received EMA/CO and of these 16 (73%) achieved a complete response, two (9%) progressed, two (9%) died of progressive disease and two (9%) were lost to follow-up. Grade 3/4 toxicities with MTX included mucositis in two (8%) and neutropenia in five (21%) patients. At a median follow-up of 16.6 months, overall survival in the low- and high-risk groups was 100 and 88.8%, respectively.


CONCLUSIONS
Risk-stratified treatment of GTN was associated with acceptable toxicity and resulted in outcome that was comparable with international standards.
Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, India.
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S
Gulia
Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, India.
J
J
Bajpai
Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, India. Electronic address: sudeepgupta04@yahoo.com.
S
S
Gupta
Department of Surgical Oncology, Tata Memorial Hospital, Parel, Mumbai, India.
A
A
Maheshwari
Department of Pathology, Tata Memorial Hospital, Parel, Mumbai, India.
K
K
Deodhar
Department of Surgical Oncology, Tata Memorial Hospital, Parel, Mumbai, India.
R A
RA
Kerkar
Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, India.
V
V
Seth
Department of Pathology, Tata Memorial Hospital, Parel, Mumbai, India.
B
B
Rekhi
Department of Pathology, Tata Memorial Hospital, Parel, Mumbai, India.
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S
Menon
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D002822:Choriocarcinoma / Q000188:drug therapy*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D003609:Dactinomycin / Q000008:administration & dosage / Q000009:adverse effects; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000188:drug therapy*; D006801:Humans; D007194:India; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D011247:Pregnancy; D016879:Salvage Therapy; D016019:Survival Analysis; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects; D055815:Young Adult
D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D008727:Methotrexate
Chemotherapy; choriocarcinoma; gestational trophoblastic neoplasia; treatment outcome