Abstract
Gestational trophoblastic neoplasia (GTN) is the malignant form of gestational trophoblastic disease. In non-metastatic GTN, the outcomes of treatment are impressive with methotrexate (MTX) or actinomycin D. We retrospectively reviewed the outcomes of non-metastatic GTN treated at our center from January, 1999 to December, 2013. One hundred and nine patients were recruited to the study. The median age was 33.1 years and over 90% were referral cases. Abnormal vaginal symptoms developed in 37.6% while 56.4% were asymptomatic. The most common antecedent pregnancy was a complete mole (92.7%) with the median interval time from antecedent pregnancy to GTN development being 2.0 months. The median pretreatment B-hCG was 5,624 mIu/ ml. The most common first line treatment was methotrexate (MTX) and folinic acid (91.7%) followed by weekly MTX (4.6%), etoposide+ MTX+actinomycin D (EMA) (2.8%), and actinomycin D (0.9%), with the median number of cycles at 5.0. The positive response to first line chemotherapy was 73.8%. The patients were given subsequent chemotherapeutic regimens after resistance to the first line therapy and showed a final remission rate of 89.9%.The significant factor that was frequently found in patients who were non-responders to the first line treatment was a hysterectomy procedure. Two patients developed lung metastasis and brain metastasis at one and four years after the first treatment, respectively. In conclusion, the outcomes of non-metastatic GTN were excellent. However, the patients need long term follow up due to the possibility of developing multiple organ metastases.
Highlights
Gestational trophoblastic neoplasia (GTN) is a rare malignant form of gestational trophoblastic disease
We retrospectively reviewed the outcomes of non-metastatic GTN treated at our center from January, 1999 to December, 2013
The most common antecedent pregnancy was a molar pregnancy with the median interval time from antecedent pregnancy to diagnosis of GTN of 2.0 months
Summary
Gestational trophoblastic neoplasia (GTN) is a rare malignant form of gestational trophoblastic disease It is classified as either invasive mole, gestational choriocarcinoma, placental site trophoblastic tumor (PSTT) or epithelioid trophoblastic tumor (ETT) (Froeling and Seckl, 2014). The low risk cases included GTN patients with the disease confined to the uterus or metastasis to gynecologic organs or lung with a WHO total risk score less than seven. There was, limited data regarding the treatment of non-metastatic GTN patients We conducted this retrospective review to identify the outcomes for this group of patients treated over twelve years at our center. These results will be beneficial for the improvement of treatment in this rare disease
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