title: Gestational trophoblastic neoplasia, management as per risk stratification in a developing country.
abstract: OBJECTIVE
  The purpose of this analysis was to address the outcome of GTN from a tertiary care centre of India.
  
  
  METHODS
  We undertook a retrospective and prospective review of GTN cases treated at our centre from 2006 to 2014. Patients of GTN were assigned to low-risk or high-risk categories as per the FIGO scoring system. The low-risk group was treated with combination of actinomycin-D and methotrexate (MTX) and the high-risk group received the EMA/CO regimen. Salvage therapy was EP/TP. Treatment was continued for 3 cycles after normalization of β-hCG level, after which the patients were kept on follow-up.
  
  
  RESULTS
  In total, 52 GTN patients were treated at our institution during this period; 21 were low-risk and 31 were in the high-risk category. The lung was the most common site of metastasis. All low risk patients achieved complete remission. Among high risk patients one patient died while receiving first cycle chemotherapy, one patient relapsed and 29 patients achieved complete remission. The single relapsed patient also achieved remission with 2nd line chemotherapy.
  
  
  CONCLUSIONS
  1. Two drug combination of Actinomycin-D and Methotrexate is a better alternative to single drug chemotherapy especially in developing countries were proper risk stratification is not always possible. 2. Patients with high disease burden should initially be treated with low dose chemotherapy to avoid life threatening visceral haemorrhage.
authors.affiliation: Medical Oncology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
authors.forename: Ansar
authors.initials: A
authors.lastname: Hussain
authors.affiliation: Medical Oncology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
authors.forename: Aejaz Aziz
authors.initials: AA
authors.lastname: Shiekh
authors.affiliation: Medical Oncology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
authors.forename: Gul Mohd
authors.initials: GM
authors.lastname: Bhat
authors.affiliation: Medical Oncology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
authors.forename: A R
authors.initials: AR
authors.lastname: Lone
keywords: Gestational; management; neoplasia