Gestational trophoblastic tumors - situation analysis in a third world regional cancer center

Abstract

A retrospective analysis of 128 cases of gestational trophoblastic tumor (GTT), registered between the years 1980 and 1993 was undertaken. As per the WHO scoring system, 35 (27.3%) were classified as low risk (LR), 32 (25%) as medium risk (MR) and 61 (47.6%) as high risk (HR). Ninety-five of 128 (34 LR, 24 MR and 37 HR) cases were considered evaluable for the purpose of treatment analysis. Complete remission (CR) was achieved in 100%, 83.3% and 83.7% of the LR, MR and HR categories respectively. While three patients were cured with surgery alone (one LR, two MR), 60/92 (26/33 LR, 13/22 MR and 21/37 HR) responded to first line chemotherapy, 22/92 (eight LR, five MR and 10 HR) were salvaged with alternative chemotherapy regimens and 10/92 (four MR and six HR) had progressive disease. There were four recurrences, all in the HR group, who could not be salvaged. It appears that at least two cycles should be administered as consolidation chemotherapy following CR, as recurrent disease (RD) was observed in 3/6 HR patients receiving one or no cycle and 1/25 HR patients receiving two or more cycles of consolidation chemotherapy (P = 0.05). Three of six HR patients with CR and WHO score > 14 developed RD as compared to 1/25 HR patients with CR and WHO score < 15 (P < 0.001). The univariate analysis of the various prognostic factors in the HR cases revealed that the initial chemotherapeutic regimen was the most important prognostic factor.