Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
권호 표지
DOI QR코드

DOI QR Code

Outcomes of Metastatic Gestational Trophoblastic Neoplasia: Fourteen Year Experience from a Northern Thailand Tertiary Care Center

  • Suprasert, Prapaporn (Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University) ;
  • Siriaree, Sitthicha (Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University) ;
  • Manopunya, Manatsawee (Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University)
  • Published : 2016.04.11
Download PDF
⟨ Previous Next ⟩

Abstract

Metastatic gestational trophoblastic neoplasia (GTN) is an uncommon cancer. The principal treatment consists of chemotherapy with or without surgery or radiotherapy. We here retrospectively reviewed the outcomes of metastatic GTN treated at our institute between January, 1999 and December, 2013. Sixty-three patients met the criteria. The median age was 30.0 years and almost 90% were referral cases. Nearly 40% of the studied patients presented with vaginal bleeding while 22.2% were asymptomatic. The most common antecedent pregnancy was hydatidiform mole (57.1%) followed by term pregnancy (20.6%). The median interval time from antecedent pregnancy to the development of GTN was three months and the median pretreatment B-hCG was 58,274 mIU/ml. Stage III (74.6%) was the most common staging followed by stage IV (20.6%) and stage II (4.8%). The most frequent surgery was hysterectomy (31.7%). Thoracotomy and craniotomy were performed in three and two patients, respectively. The most common first line chemotherapy regimen was methotrexate and folinic acid (36.5%) followed by EMA (etoposide, methotrexate, actinomycin D) (34.9%), EMACO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) (17.5%) with the remission rate of 66.7%. Nearly one-third of the patients were given a subsequent chemotherapy regimen after failure with the first line therapy and showed a final response rate of 73.0%. However, in stage IV, the response to first line treatment was only 38.5%. In conclusion, the outcomes of metastatic GTN were poor especially with the higher stages.

Keywords

References

  1. Alifrangis C, Agarwal R, Short D, et al (2013). EMA/CO for high-risk gestational trophoblastic neoplasia: good outcomes with induction low-dose etoposide-cisplatin and genetic analysis. J Clin Oncol, 31, 280-6. https://doi.org/10.1200/JCO.2012.43.1817
  2. Biscaro A, Braga A, Berkowitz RS (2015). Diagnosis, classification and treatment of gestational trophoblastic neoplasia. Rev Bras Ginecol Obstet, 37, 42-51. https://doi.org/10.1590/SO100-720320140005198
  3. Deng L, Zhang J, Wu T, et al (2013). Combination chemotherapy for primary treatment of high-risk gestational trophoblastic tumour. Cochrane Database Syst Rev, 5196.
  4. Even C, Pautier P, Duvillard P, et al (2014). Actinomycin D, cisplatin, and etoposide regimen is associated with almost universal cure in patients with high-risk gestational trophoblastic neoplasia. Eur J Cancer, 50, 2082-9. https://doi.org/10.1016/j.ejca.2014.05.002
  5. Froeling FE, Seckl MJ (2014). Gestational trophoblastic tumours: an update for 2014. Curr Oncol Rep, 16, 408-18. https://doi.org/10.1007/s11912-014-0408-y
  6. Fulop V, Szigetvari I, Szepesi J, et al (2014). Changes in the management of high-risk gestational trophoblastic neoplasia in the national trophoblastic disease center of hungary. J Reprod Med, 59, 227-34.
  7. Manopunya M, Suprasert P (2012). Resistant gestational trophoblastic neoplasia patients treated with 5-fluorouracil plus actinomycin D. Asian Pac J Cancer Prev, 13, 387-90. https://doi.org/10.7314/APJCP.2012.13.1.387
  8. Ngan HY, Kohorn EI, Cole LA, et al (2012). Trophoblastic disease. Int J Gynaecol Obstet, 119, 130-6. https://doi.org/10.1016/j.ijgo.2012.05.019
  9. Neubauer NL, Latif N, Kalakota K, et al (2012). Brain metastasis in gestational trophoblastic neoplasia: an update. J Reprod Med, 57, 288-92.
  10. Savage P, Kelpanides I, Tuthill M, et al (2015). Brain metastases in gestational trophoblast neoplasia: an update on incidence, management and outcome. Gynecol Oncol, 137, 73-6.
  11. Suprasert P, Manopunya M (2015). Outcomes of non-metastatic gestational trophoblastic neoplasia: twelve year experience from a northern thailand tertiary care center. Asian Pac J Cancer Prev, 16, 5913-6. https://doi.org/10.7314/APJCP.2015.16.14.5913
  12. Sharifi N, Shahidsales S, Haghighi F, et al (2014). Gestational throphoblastic diseases in North East of Iran: 10 years (2001-2010) prospective epidemiological and clinicopathological study. Adv Biomed Res, 3, 1-4. https://doi.org/10.4103/2277-9175.124626
  13. Seckl MJ, Sebire NJ, Fisher RA, et al (2013). Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 24, 39-50.

Cited by

  1. Total hysterectomy versus uterine evacuation for preventing post-molar gestational trophoblastic neoplasia in patients who are at least 40 years old: a systematic review and meta-analysis vol.19, pp.1, 2019, https://doi.org/10.1186/s12885-018-5168-x