title: Outcomes of women diagnosed and treated for low-risk gestational trophoblastic neoplasia at the Queensland Trophoblast Centre (QTC).
abstract: BACKGROUND
  Gestational trophoblastic neoplasia (GTN) is classified as a highly curable group of pregnancy-related malignancies; however, approximately 15% will be persistent and require chemotherapy. Up to 25% of these women will develop resistance and 2% will develop disease relapse after initial chemotherapy. Despite the need for further chemotherapy in these women, cure rates are high.
  
  
  OBJECTIVE
  To evaluate the outcomes of women diagnosed with low-risk GTN, assessing the type of treatment, the number of chemotherapy cycles received, development of resistance or disease relapse, survival, and to assess the feasibility of changing to a new drug regimen.
  
  
  METHODS
  From March 2012 until February 2015, a retrospective study was conducted and 38 cases with low-risk GTN were reviewed. The number of cycles, type of treatment received, duration of treatment, development of resistance and disease relapse, and adverse side effects were analysed.
  
  
  RESULTS
  The median duration of follow-up was 12 months. Disease-free survival was 100% and primary complete remission rates were achieved in 85.3% of patients who were treated with actinomycin D and 25% patients who were treated with methotrexate (MTX). A change in chemotherapy was required for nine patients. One patient developed disease relapse. Nausea, fatigue and constipation were the most frequent adverse events reported with actinomycin D. All women were cured of their disease.
  
  
  CONCLUSIONS
  All women were successfully treated and achieved complete remission. Changing from MTX to actinomycin D as first-line chemotherapy for women with low-risk GTN was feasible and safe.
authors.affiliation: Department of Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Lisanne
authors.initials: L
authors.lastname: Verhoef
authors.affiliation: Department of Gynaecology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Baartz
authors.affiliation: Department of Gynaecology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: Shona
authors.initials: S
authors.lastname: Morrison
authors.affiliation: Department of Gynaecologic Oncology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Sanday
authors.affiliation: Department of Gynaecologic Oncology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: Andrea Janet
authors.initials: AJ
authors.lastname: Garrett
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003609:Dactinomycin / Q000009:adverse effects / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D031901:Gestational Trophoblastic Disease / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D011247:Pregnancy; D011793:Queensland; D012074:Remission Induction; D012189:Retrospective Studies; D012306:Risk; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D003609:Dactinomycin; D008727:Methotrexate
keywords: actinomycin D; consolidation course; low-risk gestational trophoblastic neoplasia; methotrexate; relapse