Gestational Trophoblastic Neoplasia: Experience from a Tertiary Care Center of India

Abstract

Aims Gestational trophoblastic neoplasia (GTN) comprise a spectrum of interrelated conditions originating from the placenta. With sensitive assays for human chorionic gonadotropin (b-hCG) and current approaches to chemotherapy, most women with GTN can be cured with preservation of reproductive potential. The purpose of this analysis was to address the outcome of GTN in patients from a tertiary care center of India. Materials and MethodsWe undertook a retrospective and prospective review of GTN cases treated at our center over a period of 7 years from 2008 to 2014. Patients of GTN were assigned to low-risk or high-risk categories as per the FIGO scoring system. The low-risk group was treated with combination of actinomycin-D and methotrexate and the high-risk group received the Etoposide, Methotrexate, Actinomycin-D/ Cyclophosphamide, Vincristine (EMA/ CO) regimen. Salvage therapy was Etoposide, Paclitaxel / Paclitaxel, Cisplatin (EP/TP). Treatment was continued for three cycles after normalization of b-hCG level, after which the patients were followed up regularly. Results In total, 41 GTN patients were treated at our institution during the above period; 17 were in the low-risk and 24 were in the high-risk category. The lung was the most common site of metastasis. All low-risk patients achieved complete remission. Among high-risk patients, one patient died while receiving first cycle chemotherapy, one patient relapsed, and 22 patients achieved complete Conclusion Risk-stratified treatment of GTN was associated with acceptable toxicity and resulted in outcome that was comparable with international standards. The use of two-drug combination in low-risk patients is a better option especially in developing countries.

Characteristics of Referral Patients with Gestational Trophoblastic Neoplasia in Dr. Hasan Sadikin General Hospital Bandung

“…Several studies concluded that first pregnancies were associated with a higher risk of molar pregnancy. Riadh et al [7] reported a higher incidence of molar pregnancy in nulliparous women (28.88%), similar to the results obtained by Igwegbe et al [8,9]. Meanwhile, Anyanwu, et al [10] found a higher incidence of hydatidiform mole in multiparous women.…”

“…The mean gestational age of patients in this study was 10.79±4.646. According to Riadh et al [7] 81.24% of patients with molar pregnancies were diagnosed between 8 and 16 weeks. Gestational age is an essential parameter for diagnosing molar pregnancy due to the characteristic uterine size discrepancy.…”

Management of “Ultra-High Risk” Gestational Trophoblastic Neoplasia at a Tertiary Center in India

“…EMACO therapy, the standard regimen for high-risk patients can lead to catastrophic hemorrhage during the first few weeks of treatment due to rapid destruction of tumor following chemotherapy. [1] In the current study, increased morbidity was noted in patients receiving upfront EMACO therapy versus initial low dose chemotherapy. Febrile neutropenia was the most common complication probably secondary to the effects of chemotherapy.…”

“…Low-dose induction EP was introduced in patients with a high burden of disease at presentation to enable a more gradual reduction in tumor bulk in the initial weeks of treatment to minimize the risk of early death. [1] Alifrangis et al conducted a retrospective study at Charring Cross Hospital, UK. [4] Between 1979 and 1995, overall survival with EMACO in high-risk GTN at their institute was 85.4%, with a significant proportion of early deaths (<4 weeks).…”

“…Gestational trophoblastic neoplasia (GTN) comprises malignant trophoblastic disorders, namely invasive mole, choriocarcinoma (CC), placental site trophoblastic tumor, and the extremely rare epithelioid trophoblastic tumor. [1][2][3] GTN has been divided into "low risk" and "high risk" tumors based on the FIGO prognostic score. [4] Low-risk GTN has excellent remission rates with cure rates noted to be approaching 100%.…”