Analysis of the treatment and prognosis for gestational trophoblastic neoplasia patients with urinary system and adrenal glands metastasis

Abstract

To analyze the treatment and prognosis of patients with gestational trophoblastic neoplasia with urinary system and adrenal glands metastasis. The treatment and prognoses of 32 patients with gestational trophoblastic neoplasia with urinary system and adrenal glands metastasis from Dec. 1990 to Dec. 2010 at Peking Union Medical College Hospital, Chinese Academy of Medical Sciences were respectively reviewed. Treatment methods: all 32 patients received 9 courses(in average) of a multi- drug chemotherapy in our hospital (range 1-24 coures). Among them, 3 patients with bladder metastasis received intravesical chemotherapy of fluorouracil. 9 patients received surgical treatments in other hospital and 15 patients received surgical treatments while undergoing chemotherapy in our hospital. Treatment results: after the treatments, of the 32 patients, 21 (66%) patients achieved complete remission, 3(9%) exhibited partial remission and 8 (25%) progressed. Seven patients with renal metastasis achieved complete remission. Two patients with adrenal glands metastasis achieved complete remission. Nine patients with urinary bladder metastasis achieved complete remission. Seven patients with ureters metastasis achieved complete remission. Two (10% ) of 21 patients with complete remission relapsed. Multidrug and multiroute chemotherapy is the main strategy for patients with gestational trophoblastic neoplasia with urinary system and adrenal glands metastasis. The prognoses of patients with renal or adrenal glands metastasis are much worse than those in patients with bladder and ureters metastasis because of concomitant multiogran metastasis. Adequate attention should be given to patients with renal or adrenal glands metastasis. Individual treatment, assisted by surgery when necessary, may be carried out for these patients to achieve a better outcome.