title: Management and survival of patients with FIGO high-risk gestational trophoblastic neoplasia: the U.K. experience, 1995-2010.
abstract: OBJECTIVE
  To present survival rates of high-risk gestational trophoblastic neoplasia (GTN) (FIGO score > 7) patients treated between 1995 and 2010 in the U.K. Death due to GTN is largely confined to patients with high-risk disease. In the U.K. a national system ensures that all patients are treated at only 2 specialist centers: Charing Cross Hospital (CXH) in London and Weston Park Hospital (WPH) in Sheffield.
  
  
  METHODS
  A total of 196 high-risk patients were identified using the CXH and WPH GTN databases, based on the risk score at the time of presentation.
  
  
  RESULTS
  In all, 140 CXH and 56 WPH high-risk patients were treated with EMA/CO (etoposide, methotrexate, actinomycin D alternating with cyclophosphamide and vincristine) and MEA (methotrexate, etoposide, actinomycin D), respectively. The FIGO score at presentation ranged from 6-23. Eight patients (7from WPH and 1 from CXH) who were treated prior to 2002 as high-risk based on their pre-2002 scoring scored a 6 using FIGO 2002. Two (1%) patients died within 4 weeks of starting treatment (early death), 12 (6%) relapsed, and 9 patients subsequently died due to drug resistance. The overall survival was 94%, with a median follow-up of 4.69 years.
  
  
  CONCLUSIONS
  In the context of a national trophoblastic disease service, patients with high-risk GTN have an excellent prognosis with EMA/CO or MEA.
authors.affiliation: Charing Cross Gestational Trophoblastic Disease Centre, Department of Medical Oncology, Charing Cross Hospital, Imperial College Academic Science NHS Trust, UK.
authors.forename: Roshan
authors.initials: R
authors.lastname: Agarwal
authors.affiliation: Charing Cross Gestational Trophoblastic Disease Centre, Department of Medical Oncology, Charing Cross Hospital, Imperial College Academic Science NHS Trust, UK.
authors.forename: Costi
authors.initials: C
authors.lastname: Alifrangis
authors.affiliation: Charing Cross Gestational Trophoblastic Disease Centre, Department of Medical Oncology, Charing Cross Hospital, Imperial College Academic Science NHS Trust, UK.
authors.forename: Janet
authors.initials: J
authors.lastname: Everard
authors.affiliation: Charing Cross Gestational Trophoblastic Disease Centre, Department of Medical Oncology, Charing Cross Hospital, Imperial College Academic Science NHS Trust, UK.
authors.forename: Philip M
authors.initials: PM
authors.lastname: Savage
authors.affiliation: Charing Cross Gestational Trophoblastic Disease Centre, Department of Medical Oncology, Charing Cross Hospital, Imperial College Academic Science NHS Trust, UK.
authors.forename: Dee
authors.initials: D
authors.lastname: Short
authors.affiliation: Charing Cross Gestational Trophoblastic Disease Centre, Department of Medical Oncology, Charing Cross Hospital, Imperial College Academic Science NHS Trust, UK.
authors.forename: John
authors.initials: J
authors.lastname: Tidy
authors.affiliation: Charing Cross Gestational Trophoblastic Disease Centre, Department of Medical Oncology, Charing Cross Hospital, Imperial College Academic Science NHS Trust, UK.
authors.forename: Rosemary A
authors.initials: RA
authors.lastname: Fisher
authors.affiliation: Charing Cross Gestational Trophoblastic Disease Centre, Department of Medical Oncology, Charing Cross Hospital, Imperial College Academic Science NHS Trust, UK.
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Sebire
authors.affiliation: Charing Cross Gestational Trophoblastic Disease Centre, Department of Medical Oncology, Charing Cross Hospital, Imperial College Academic Science NHS Trust, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Harvey
authors.affiliation: Charing Cross Gestational Trophoblastic Disease Centre, Department of Medical Oncology, Charing Cross Hospital, Imperial College Academic Science NHS Trust, UK.
authors.forename: Barry W
authors.initials: BW
authors.lastname: Hancock
authors.affiliation: Charing Cross Gestational Trophoblastic Disease Centre, Department of Medical Oncology, Charing Cross Hospital, Imperial College Academic Science NHS Trust, UK.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Coleman
authors.affiliation: Charing Cross Gestational Trophoblastic Disease Centre, Department of Medical Oncology, Charing Cross Hospital, Imperial College Academic Science NHS Trust, UK.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Seckl
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 / Q000627:therapeutic use; D003609:Dactinomycin / Q000008:administration & dosage / Q000627:therapeutic use; D019008:Drug Resistance, Neoplasm; D005047:Etoposide / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D006782:Hospitals, Special; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011247:Pregnancy; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D006113:United Kingdom; D014750:Vincristine / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D006063:Chorionic Gonadotropin; D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D008727:Methotrexate