Chemo-resistant gestational trophoblastic neoplasia, 5-years experience of Mansoura University Hospital, Egypt

Abstract

Introduction: Gestational trophoblastic neoplasia (GTN), is recognized as the most curable gynaecologic malignancy. However, many cases are resistant to first line chemotherapy. Objective: The aim of the study is to report our 5 years experience in the management of GTN cases with special stress on the chemo-resistant cases. Methods: The study was performed through reviewing the records of 51 patients who were diagnosed as GTN during the period from 1/1/2006 to 31/12/2010 in Mansoura University Hospital, Egypt. Results: Resistance to methotrexate therapy was reported in 15.15% of low risk cases and received etoposide or cisplatinum/etoposide. Sixty percent of high risk cases were resistant to MAC combination and received salvage chemotherapy or hysterectomy. There was significant correlation between patient response and initial B-hCG, as well as WHO risk score (P value = 0.001 in both) but correlations with age, parity, type of antecedent pregnancy, and histopathology were non significant (p = 0.95, 0.53, 0.47& 0.83 respectively). Conclusion: Low risk GTN cases who were resistant to methotrexate monotherapy received etoposide or cisplatinum/etoposide as a second-line therapy. High risk GTN cases who were resistant to MAC combination received second-line combination chemotherapy and/or hysterectomy. WHO risk score and initial B-hCG were correlated to resistance to first line chemotherapy.