Treatment outcome of gestational trophoblastic neoplasia patients in Egypt.

Abstract

Gestational trophoblastic neoplasia (GTN) are a spectrum of tumors that develop from placental tissue. We aimed to evaluate the management and treatment outcome of GTN. Patients diagnosed with GTN presented to Kasr Alainy Center of Clinical Oncology between 2008 and 2017 were included in this study. Patients were assigned to low or high-risk according to the World Health Organization (WHO) scoring system. All data were tabulated and statistically studied by descriptive analysis; comparison between the two groups was done using student t-test for continuous data and Chi-square test for categorical data. A total of 111 patients were studied; the majority of them had WHO low-risk score. In low-risk group, the overall response rate to methotrexate-folinic acid (MTX- FA) or actinomycin D (ActD) was 48.5%, comparable response rate observed between MTX and ActD was 48.2% vs 50%, respectively. Those who received MTX-FA 8-day regimen had higher response rate compared to a weekly schedule, however, no statistical significant difference was observed (51.6% vs 44.4%, respectively, P = 0.586), all low-risk patients who failed MTX or ActD achieved complete remission (CR) with subsequent chemotherapy. Patients with WHO score 5-6 had a significantly lower CR rate compared to patients with scores <5, (28% and 60%, respectively; P = 0.01). Five-years overall survival was significantly lower in high-risk than low-risk patients (79.3% vs 100%, respectively, P = <0.001). Low-risk patients have a survival rate of 100% even if they did not respond to first-line chemotherapy, MTX-FA 8-day regimen seems to be more effective than MTX weekly regimen.