Prophylactic Chemotherapy with Methotrexate Leucovorin in High-Risk Hydatidiform Mole.

Soheila Aminimoghaddam,Fatemeh Mahmoudzadeh,Marzieh Mohammadi

doi:10.31557/apjcp.2020.21.6.1755

Abstract

Aim:Gestational Trophoblastic Neoplasia (GTN) is used to describe a group of malignant gestational tumors originating from the placenta. The chance of having malignant GTN is high in a high-risk molar pregnancy. The main aim of this study is to investigate the effectiveness of using prophylactic chemotherapy in high-risk molar pregnancy to prevent malignant GTN. Method:In this case-control retrospective study, all patients with high-risk mole referred to Firoozgar and Akbarabadi Hospitals affiliated with Iran University of Medical Sciences (IUMS) from 2003 to 2013 were divided into two groups of recipient and non-recipient of methotrexate prophylactic chemotherapy.Demographic information including age, parity, weight, serum βHCG before and after the intervention, level of liver function tests (LFT) and GTN were analyzed. Results:There were 102 patients with a mean age of 27.13 years (SD= 0.37), and 51 patients (50 %) received prophylactic Methotrexate (MTX), and others were the non-receivers. Finally, 23 patients (22.5%) were inflicted with GTN, and 79 (77.5 %) did not. The average time of βHCG spontaneous remission between the groups were 2.5 (SD=1.33) and 3.2 (SD=1.21), for the recipient and non-recipient, respectively, which showed a significant difference (p). Conclusion:This study concludes that prophylactic chemotherapy with MTX and leucovorin may be capable of reducing GTN, which supports the prescription of MTX in high-risk mole, especially in countries with limited resources. The toxicity of methotrexate can be reduced with the addition of leucovorin.

Highlights

Gestational Trophoblastic disease is a continuum, which covers a wide range of states from benign molar pregnancy to Gestational Trophoblastic Neoplasia (GTN) (Aminimoghaddam et al, 2018; Rachdi et al, 2019)
In this case-control retrospective study, all patients with high-risk mole referred to Firoozgar and Akbarabadi Hospitals affiliated with Iran University of Medical Sciences (IUMS) from 2003 to 2013 were divided into two groups of recipient and non-recipient of methotrexate prophylactic chemotherapy.Demographic information including age, parity, weight, serum βHCG before and after the intervention, level of liver function tests (LFT) and GTN were analyzed
This study concludes that prophylactic chemotherapy with MTX and leucovorin may be capable of reducing GTN, which supports the prescription of MTX in high-risk mole, especially in countries with limited resources

Summary

Introduction

Gestational Trophoblastic disease is a continuum, which covers a wide range of states from benign molar pregnancy to Gestational Trophoblastic Neoplasia (GTN) (Aminimoghaddam et al, 2018; Rachdi et al, 2019). Molar pregnancy is divided into three categories; complete, partial, and invasive mole, and malignant form (Hurteau, 2003). Malignant form is a rare disease, which is divided into three categories; choriocarcinoma, Placental Site Trophoblastic Tumor (PSTT), Epithelioid Trophoblastic Tumor (Aminimoghaddam et al, 2016). To define the characteristics of each type of molar pregnancies, trophoblastic proliferation should be addressed. Trophoblastic proliferation is excessive, while, a few trophoblastic tissue is detected in partial mole (Seckl et al, 2010). Trophoblastic invasion into the myometrium followed by villous formation are detected (Milani, 2017). The GTN can be detected in different situations; after evacuation of molar pregnancy (with 50% occurrence rate), after term pregnancy (with 25% occurrence rate), and after ectopic pregnancy abortion (with 25% occurrence rate) (Altieri et al, 2003)

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