Hotspots of low-risk gestational trophoblastic neoplasia treatment

Abstract

Single-agent chemotherapy is the preferred treatment for patients with low-risk gestational trophoblastic neoplasia (GTN), and the commonly used drugs are methotrexate (MTX) and actinomycin-D (Act-D). At present, most studies show that Act-D single-agent chemotherapy is more effective than MTX in treatment of low-risk GTN patients, but the samples sizes and qualities of these studies are insufficient, and more large samples, multi-center randomized controlled trials are needed to confirm the conclusions. Although low-risk GTN has a generally good prognosis after single-agent chemotherapy, more and more studies have shown that low-risk GTN patients who got 5-6 scores from Clinical Staging and Prognosis Scoring Systems for Gestational Trophoblastic Neoplasia (FIGO 2000) by the International Federation of Gynecology and Obstetrics (FIGO) or had metastasis shown poor response to the first-line single-agent chemotherapy. Therefore, it is worth exploring whether the combination chemotherapy is the first choice for these patients. This review focuses on elaborating the major chemotherapy regimens of low-risk GTN, the advantages and disadvantages of MTX and Act-D in the treatment of low-risk GTN, as well as other treatment strategies of low-risk GTN, such as second curettage, total hysterectomy and expectant therapy, in order to provide a reference for clinicians to diagnose and treat the disease. Key words: Gestational trophoblastic neoplasms; Risk assessment; Drug therapy, monotherapy; Antineoplastic combined chemotherapy protocols; Dactinomycin; Methotrexate; Hysterectomy; Female