title: A 30-year experience in using oral methotrexate as initial treatment for gestational trophoblastic neoplasia regardless of risk group.
abstract: BACKGROUND
  Treatment of postmolar gestational trophoblastic neoplasia (GTN) is often stratified according to FIGO score using methotrexate (MTX) for low-risk patients and first-line multi-agent chemotherapy (e.g. EMA-CO) for high-risk patients. In contrast, oral MTX may be given as first-line therapy to all GTN patients regardless of risk group. The aim was to examine the efficacy of oral MTX and a response-adapted treatment policy, which has been used for three decades at Aarhus University Hospital (AUH).
  
  
  METHODS
  Seventy-one consecutive postmolar GTN patients treated 1981-2011 were included. Data were obtained from medical records, using histopathology and human choriogonadotropin (hCG) to verify the diagnosis. All patients received oral MTX as first-line chemotherapy. Second- and third-line chemotherapy was given according to response.
  
  
  RESULTS
  Sixty-four (90%) patients were retrospectively categorized as FIGO low-risk disease, whereas seven patients (10%) had high-risk disease. Complete response to first-line oral MTX chemotherapy was observed in 35/71 (49%) patients, while 62/71 (87%) had complete remission on MTX (first-line) and/or MTX plus dactinomycin (second-line), without the use of multi-agent therapy. Nine patients (13%) received third-line multi-agent chemotherapy, six low-risk (67%) and three high-risk (33%) patients. There were no recurrences and no patients died as a consequence of toxicity or disease.
  
  
  CONCLUSIONS
  Fifty percent of all patients can be cured on oral MTX alone. By adding dactinomycin, about 90% are cured without use of multi-agent chemotherapy. The use of oral MTX as initial treatment can minimize the number of patients receiving multi-agent chemotherapy.
authors.affiliation: a Department of Oncology , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Louise
authors.initials: L
authors.lastname: Faaborg
authors.affiliation: b Department of Obstetrics and Gynecology , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Isa
authors.initials: I
authors.lastname: Niemann
authors.affiliation: c Department of Clinical Epidemiology , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Eva B
authors.initials: EB
authors.lastname: Ostenfeld
authors.affiliation: d Department of Pathology , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Estrid S
authors.initials: ES
authors.lastname: Hansen
authors.affiliation: e Department of Clinical Genetics Aarhus University Hospital , Aarhus , Denmark.|f Department of Biomedicine , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Lone
authors.initials: L
authors.lastname: Sunde
authors.affiliation: a Department of Oncology , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Jacob C
authors.initials: JC
authors.lastname: Lindegaard
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; 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; D005047:Etoposide / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D031901:Gestational Trophoblastic Disease / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage* / Q000627:therapeutic use; D008875:Middle Aged; D011247:Pregnancy; D012307:Risk Factors; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D006063:Chorionic Gonadotropin; D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D008727:Methotrexate