Chemotherapeutic and immunological aspects of choriocarcinoma.

Abstract

There are two types of choriocarcinoma, namely that originating from the placenta, the result of union of two genetically different germ-cells, and that from the primordial cells in gonads of both sexes, or, very uncommonly, in various extragonadal sites consisting of the host's genetic element. Both gestational and nongestational choriocarcinomas are characterized by rapid cellular proliferation and dissemination, causing a mortality rate of over 90% in untreated patients. Multiple hormonal production, particularly chorionic gonadotropin is a unique feature. In 1956 Li, Hertz, and Spencer documented the extreme sensitivity of gestational choriocarcinoma to a folic acid antagonist, methotrexate, as evidenced by complete tumor resolution, and that the urinary chorionic gonadotropin titre was a very sensitive and reliable index of tumor response. 1 Subsequent national and international studies reported a five- to ten-year cure rate in about 50% of the patients so treated. 2 In 1961 Li further found dactinomycin effective against