Gestational trophoblastic neoplasia: treatment outcomes from a single institutional experience.
OBJECTIVE
To report the outcomes of gestational trophoblastic neoplasia (GTN) at a single institution and to determine the factors affecting response to chemotherapy and survival.


METHODS
From 1979-2010, we retrospectively reviewed the data of 221 patients treated at our center. GTN Patients were assigned to low-risk (score ≤6) or high-risk (score ≥7) based on the WHO risk factor scoring system. Overall survival (OS) probabilities were estimated using Kaplan-Meier method. Logistic regression was applied to study the impact of different factors on the response to initial therapy.


RESULTS
Patients' OS rate was 97 %. Median age at diagnosis was 37 year. 131 (59 %) patients had low-risk and 88 (40 %) cases had high-risk GTN. Complete remission rates to initial chemotherapy in low-risk group were 53 % and 87 % for single-agent methotrexate or dactinomycin, respectively. In high-risk group, 94 % achieved complete remission to initial chemotherapy with etoposide, methotrexate, dactinomycin, cyclophosphamide, and vincristine (EMA-CO). Etoposide, cisplatin, and dactinomycin as primary therapy in high-risk patients was successful in 70 %, while bleomycin, etoposide, and cisplatin (BEP) was successful in 53 % of cases. Salvage chemotherapy, surgical intervention or radiation therapy resulted in overall complete remission of 90 % in low-risk and 73 % in high-risk groups. Factors associated with resistance to initial chemotherapy were advanced-stage III/IV (p = 0.005), metastatic site other than lung or vagina (p = 0.005) and high-risk prognostic score (p = 0.05). OS was significantly influenced by the type of antecedent pregnancy (molar 98 % vs. others 93 %; p = 0.04), FIGO stage (I, II 100 % vs. III, IV 94 %; p = 0.02), score (low-risk 100 % vs. high-risk 92 %; p = 0.01), and site of metastasis (lung/vagina 98 % vs. others 85 %; p = 0.002).


CONCLUSIONS
GTNs have excellent prognosis if properly treated at experienced centers. Single-agent dactinomycin seems more effective for low-risk GTN. EMA-CO remains the preferred primary treatment regimen for high-risk group. The excellent outcome reflects the success of salvage therapy.
Medical Oncology Consultant, King Faisal Cancer Center, King Faisal Specialist Hospital & Research Center, P.O. Box 3354, MBC 64, Riyadh, 11211, Saudi Arabia, hhusseini@kfshrc.edu.sa.
H
H
Al-Husaini
H
H
Soudy
A
A
Darwish
M
M
Ahmed
A
A
Eltigani
W
W
Edesa
T
T
Elhassan
A
A
Omar
W
W
Elghamry
H
H
Al-Hashem
S
S
Al-Hayli
I
I
Madkhali
S
S
Ahmad
I A
IA
Al-Badawi
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000556:secondary / Q000628:therapy; D002822:Choriocarcinoma / Q000556:secondary / Q000628:therapy*; D002945:Cisplatin / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D003609:Dactinomycin / Q000627:therapeutic use; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000556:secondary / Q000628:therapy*; D006801:Humans; D007044:Hysterectomy; D008113:Liver Neoplasms / Q000556:secondary / Q000628:therapy; D008175:Lung Neoplasms / Q000556:secondary / Q000628:therapy; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D009367:Neoplasm Staging; D011247:Pregnancy; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy; D015996:Survival Rate; D014594:Uterine Neoplasms / Q000473:pathology / Q000628:therapy*; D014625:Vaginal Neoplasms / Q000556:secondary / Q000628:therapy; D014750:Vincristine / Q000627:therapeutic use; D055815:Young Adult
D001761:Bleomycin; D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D002945:Cisplatin; D008727:Methotrexate