title: A retrospective study to evaluate single agent methotrexate treatment in low risk gestational choriocarcinoma in the United Kingdom.
abstract: OBJECTIVE
  To determine whether single agent chemotherapy with intramuscular methotrexate 50mg administered on days 1, 3, 5, and 7 and oral folinic acid 15mg administered on days 2, 4, 6, and 8 in 2 weekly cycles (IM MTX/FA) is an effective treatment regimen for patients with low risk gestational choriocarcinoma.
  
  
  METHODS
  Electronic databases were searched to identify patients with gestational choriocarcinoma at the Sheffield and Charing Cross supra-regional trophoblastic disease centres from January 2000 to December 2011. Clinical notes of low risk patients with FIGO score 0-6 were retrospectively reviewed to assess treatment outcomes and subsequent relapse.
  
  
  RESULTS
  65 patients were identified with low risk choriocarcinoma. Serum hCG levels normalised in 24 patients without the requirement of chemotherapy (19 with histological confirmation, 4 highly suspicious histology and 1 clinical diagnosis). Of 23 patients with histologically confirmed choriocarcinoma, 8 (35%) had a sustained complete response to IM MTX/FA and did not relapse. Both patients with FIGO score 6, and 1 patient with FIGO stage III metastatic disease developed resistance to IM MTX/FA and required further treatment. Despite the development of drug resistance or relapse all patients were successfully salvaged by subsequent treatments.
  
  
  CONCLUSIONS
  Not all patients with low risk choriocarcinoma that have had primary intervention prior to staging, such as surgical resection or uterine evacuation will require chemotherapy, providing hCG levels continue to decline to normal. Low risk (FIGO 0-5) patients should initially receive IM MTX/FA due to its low toxicity, outpatient administration and reasonable efficacy. Patients with FIGO score 6 or FIGO stage III disease should make an informed choice between IM MTX/FA and combination chemotherapy.
authors.affiliation: Sheffield Centre for Trophoblastic Disease, Weston Park Hospital, Sheffield, UK. Electronic address: F.Taylor@sheffield.ac.uk.
authors.forename: F
authors.initials: F
authors.lastname: Taylor
authors.affiliation: Trophoblastic Tumour Screening and Treatment Centre, Department of Medical Oncology, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
authors.forename: D
authors.initials: D
authors.lastname: Short
authors.affiliation: Sheffield Centre for Trophoblastic Disease, Weston Park Hospital, Sheffield, UK.
authors.forename: M C
authors.initials: MC
authors.lastname: Winter
authors.affiliation: Sheffield Centre for Trophoblastic Disease, Weston Park Hospital, Sheffield, UK.
authors.forename: J
authors.initials: J
authors.lastname: Tidy
authors.affiliation: Trophoblastic Tumour Screening and Treatment Centre, Department of Medical Oncology, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
authors.forename: P M
authors.initials: PM
authors.lastname: Savage
authors.affiliation: Trophoblastic Tumour Screening and Treatment Centre, Department of Medical Oncology, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
authors.forename: N
authors.initials: N
authors.lastname: Sarwar
authors.affiliation: Sheffield Centre for Trophoblastic Disease, Weston Park Hospital, Sheffield, UK.
authors.forename: B W
authors.initials: BW
authors.lastname: Hancock
authors.affiliation: Trophoblastic Tumour Screening and Treatment Centre, Department of Medical Oncology, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Seckl
authors.affiliation: Sheffield Centre for Trophoblastic Disease, Weston Park Hospital, Sheffield, UK.
authors.forename: R E
authors.initials: RE
authors.lastname: Coleman
mesh_terms: D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D002822:Choriocarcinoma / Q000097:blood / Q000188:drug therapy*; D006063:Chorionic Gonadotropin / Q000097:blood; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D006113:United Kingdom
chemical_list: D000964:Antimetabolites, Antineoplastic; D006063:Chorionic Gonadotropin; D008727:Methotrexate
keywords: Chemotherapy; FIGO/WHO prognostic staging system; Gestational choriocarcinoma; Low risk; Methotrexate; Resistance