title: Evaluation of weekly intramuscular methotrexate in the treatment of low risk gestational trophoblastic neoplasia.
abstract: BACKGROUND
  The gestational trophoblastic neoplasms (GTNs) are rare and potentially life-threatening malignancies.
  
  
  OBJECTIVE
  The aim of this study was to determine the rate of response to weekly intramuscular (IM) methotrexate (MTX) in patients with low-risk GTN (LR-GTN).
  
  
  METHODS
  The study was designed cross-sectional and prospectively. Patients followed for 1 year.
  
  
  METHODS
  From 2006 to 2011, a total of 117 women with LR-GTN were studied. A weekly MTX regimen (50 mg/m² with dose escalation to 75 mg/m²) was administered to 87 of patients. A biweekly pulsed intravenous bolus of 1.25 mg/m² of actinomycin D was administered in patients resistant to MTX (n = 30) and combination therapy was performed in those who did not respond to aforesaid treatments (n = 8).
  
  
  METHODS
  The data were analyzed using Statistical Package for Social Sciences (SPSS) 11.5 and Chi-square model was applied. Descriptive statistics and compare means (t-test) was used as well. P < 0.05 was statistically significant.
  
  
  RESULTS
  All 117 patients with LR-GTN were cured. The primary remission rate was 74.3%, with primary dose of 50 mg/m² of MTX and escalation to 75 mg/m². Another patient achieved complete remission with actinomycin and combination chemotherapy. There were significant statistical correlation between remission and World Health Organization (WHO) scoring, International Federation of Gynecology and Obstetrics (FIGO) staging, pretreatment beta-human chorionic gonadotropin (β-hCG) level, and antecedent pregnancy (P < 0.05).
  
  
  CONCLUSIONS
  We suggest that cases with score ≥6 should be considered high risk. First-line combination chemotherapy is advised in GTN with score ≥6.
authors.forename: Malihe
authors.initials: M
authors.lastname: Hasanzadeh
authors.affiliation: Renal Basic Science Laboratory, Brigham and Women's Hospital, Harvard Medical School, USA.
authors.forename: Azadeh
authors.initials: A
authors.lastname: Tabari
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Homae
authors.forename: Mohammadtaghi
authors.initials: M
authors.lastname: Shakeri
authors.forename: Tahereh
authors.initials: T
authors.lastname: Bakhshandeh
authors.forename: Faezeh
authors.initials: F
authors.lastname: MadaniSani
mesh_terms: D000293:Adolescent; D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D003430:Cross-Sectional Studies; D004334:Drug Administration Schedule; D016903:Drug Monitoring; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000378:metabolism*; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011247:Pregnancy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000964:Antimetabolites, Antineoplastic; D018997:Chorionic Gonadotropin, beta Subunit, Human; D008727:Methotrexate