Cyclophosphamide, Hydroxyurea, Actinomycin D, Methotrexate, and Vincristine in the Treatment of Gestational Trophoblastic Neoplasia

Chu, Mandy Man Yee; Ma, Yaomei; Tse, Ka Yu; Chan, Karen Kar Loen; Ngan, Hextan Y.S.

doi:10.1097/igc.0000000000000383

Cited by 13 publications

(8 citation statements)

References 25 publications

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“…The metrorrhagias, found in 84% to 97% of the cases, are spontaneous, capricious, of increasing abundance; and are due to erosion of the uterine walls in the absence of placentation. 8 In our case there was no metrorrhagias.…”

Section: Our Patient Presented Most Of This Risk Factorssupporting

confidence: 46%

Near death 18 weeks preeclampsia in molar pregnancy

Saad¹,

Tanouti²,

Bkiyar³

et al. 2020

Int J Reprod Contracept Obstet Gynecol

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Authors present a case of a molar pregnancy of 18 weeks with preeclampsia complicated with acute pulmonary oedema. A condition carrying a significant risk to mother, therefore, raising an important issue on preeclampsia symptoms on pregnancies before 20 weeks. A 31-year-old woman gravida 2, parity 1 presented with dyspnea at 18 weeks' gestation. Blood pressure was very high (180/110 mmHg) and there was markedly proteinuria (+4). She had severe dyspnea and her oxygen saturation level was 75%. Her chest X-ray graph showed massive acute pulmonary oedema. Ultrasonography shows endometrial cavity containing multiple small cystic spaces, creating a characteristic “snowstorm” and “cluster of grapes” appearance. Markedly elevated quantitative human chorionic gonadotropin (250.000 mIU/mL). The acute pulmonary oedema has been managed by diuretics (Furosemide) and oxygen. There was no cardiac abnormalities in the tranthoracic echocardiogram. Authors administered antihypertensive therapy (intravenous nicardipine and lmethyldopa in per os), and magnesium sulfate in prevention of eclamptic seizures. The pregnancy was terminated by uterine evacuation under oxytocin infusion by manual ultrasound aspiration. She was followed up intensive care unit for two days. Causes of secondary high blood pressure had been eliminated. The patient's blood pressure rapidly normalized two days after delivery. Dyspnea disappeared one day later. Pathologic and cytogenetic analyses revealed a complete hydatiform mole. Two days after delivery; the serum β-hCG level was 99000 mlU/ml. A control ultrasonography shows an empty uterus. Hydatidiform mole is classified into 2 different subtypes, complete hydatidiform mole and partial or incomplete hydatidiform mole development of preeclampsia prior to 20 weeks of gestation should prompt a clinical evaluation to exclude the possibility of an underlying hydatidiform molar pregnancy. Ultrasonography and level of serum BHCG are the initial investigation of choice for the detection of hydatidiform mole. Aspiration is the treatment of reference.

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Section: Our Patient Presented Most Of This Risk Factorssupporting

confidence: 46%

Near death 18 weeks preeclampsia in molar pregnancy

Saad¹,

Tanouti²,

Bkiyar³

et al. 2020

Int J Reprod Contracept Obstet Gynecol

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“…Après l'introduction de la chimiothérapie, les taux de guérison des môles invasives ont augmenté significativement. En raison de leur remarquable chimio-sensibilité, les taux de guérison sont de près de 100% dans le groupe à faible risque et de près de 80% dans le groupe à haut risque avec les protocoles de polychimiothérapie actuels (36)(37)(38)(39).La polychimiothérapie est la meilleure option, et le diagnostic histologique n'est pas obligatoire pour l'initiation de la chimiothérapie. Le diagnostic repose sur l'imagerie diagnostique,letaux de béta-HCG, et le contexte clinique (7).…”

Section: Discussion:-unclassified

Les Moles Invasives :Presentations Cliniques Et Prise en Charge Therapeutique. (A Propos De2 Cas Et Revue De La Litterature)

Mohamed¹,

Zizi²,

Mamouni³

et al. 2020

IJAR

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Gestational trophoblastic diseases present a risk of malignant, invasive and metastatic progression, hence the advantage of rigorous biological monitoring after any molar evacuation, with the aim of detecting any malignancy early, and consequently reducing the mortality of these diseases. The therapeutic approach y is based on chemotherapy, but embolization and hysterectomy must be taken on consideration especially in the haemorrhagic forms of the disease.

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“…Cyclophosphamide has a wide spectrum of documented clinical use and is often included in combination regimens for the treatment of refractory tumours [6,16,[26][27][28]. The combination of chemotherapy and radiotherapy has been used with a remarkable success, especially in cases, where either therapy alone has proved ineffective.…”

Section: Discussionmentioning

confidence: 99%

The Combination Cyclophosphamide with Radiation Increases Tumour Cure in Ehrlich Ascites Carcinoma Bearing Mice as well as DNA Damage in the Normal Mice Bone Marrow Exposed to Different Doses of Γ-Radiation

Jagetia

2018

CTBEB

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Alterations in the radiation-induced micronuclei formation was studied in mice bone marrow treated with 0.5mg/kg body weight (1/500 th of the LD 50 ) of cyclophosphamide (CPA) before exposure to 0, 0.5, 1, 2 and 3Gy of γ-radiation. Irradiation of animals caused a dose dependent elevation in the Micro-nucleated Polychromatic Erythrocytes (MPCE) and Micro nucleated Norm chromatic Erythrocytes (MNCE) in the bone marrow of mice at 24h post-irradiation. Treatment of mice with 0.5mg/kg CPA elevated the radiation-induced MPCE significantly up to 2Gy irradiation and showed a significant decline thereafter when compared to the concurrent sterile physiological saline (SPS) treated irradiated group. The frequency of radiation-induced MNCE also showed a significant elevation after CPA treatment at all exposure doses. In a separate experiment the effect of 0.5mg/kg b. wt. CPA was evaluated in combination with radiation in the Ehrlich Ascites Carcinoma bearing mice (EAC). The combination of 0.5mg/kg b. wt. of CPA with 1, 2, 4, 6 and 8Gy of irradiation increased both the Median Survival Time (MST) and Average Survival Time (AST) of the EAC bearing mice when compared with the SPS+ irradiation and the maximum effect was observed in mice that received CPA and 8Gy of radiation. Our study demonstrates that the risk of genomic instability and mutagenesis outweighs the benefit accrued in the tumor bearing mice receiving combination of CPA and ionizing radiation.

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Cyclophosphamide, Hydroxyurea, Actinomycin D, Methotrexate, and Vincristine in the Treatment of Gestational Trophoblastic Neoplasia

Abstract: The CHAMOC regimen should be considered as an alternative to other chemotherapy regimens in the primary treatment of high-risk gestational trophoblastic disease, with comparable efficacy, similar short-term side-effects profile, and potentially fewer long-term complications.

Cited by 13 publications

References 25 publications

Near death 18 weeks preeclampsia in molar pregnancy

Near death 18 weeks preeclampsia in molar pregnancy

Les Moles Invasives :Presentations Cliniques Et Prise en Charge Therapeutique. (A Propos De2 Cas Et Revue De La Litterature)

The Combination Cyclophosphamide with Radiation Increases Tumour Cure in Ehrlich Ascites Carcinoma Bearing Mice as well as DNA Damage in the Normal Mice Bone Marrow Exposed to Different Doses of Γ-Radiation

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