Metastatic gestational trophoblastic disease: A comparison of prognostic classification systems

Dubuc-Lissoir, Josée; Sweizig, Susan; Schlaerth, John B.; Morrow, C. Paul

doi:10.1016/0090-8258(92)90488-5

Cited by 27 publications

(10 citation statements)

References 14 publications

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“…Singleagent chemotherapy also produced remissions in 55 out of 66 (87%) and 13 out of 17 (76%) of low-and medium-risk patients with metastatic disease. Other authors have also reported remission rates of over 80% for this group of patients (Dubeshter et al, 1987;Ayhan et al, 1992;Dubuc-Lissoir et al, 1992).…”

Section: Discussionsupporting

confidence: 52%

Low-risk persistent gestational trophoblastic disease treated with low-dose methotrexate: efficacy, acute and long-term effects

et al. 2003

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The aim of this study was to evaluate the efficacy and toxicity of low-dose methotrexate with folinic acid rescue in a large series of consecutively treated patients with low-risk persistent gestational trophoblastic disease. Between January 1987 and December 2000, 250 patients were treated with intramuscular methotrexate (50 mg on alternate days 1, 3, 5, 7) with folinic acid (7.5 mg orally on alternate days 2, 4, 6, 8) rescue. The overall complete response rate without recurrence was 72% for first-line treatment and 95% for those who required second-line chemotherapy. Eight women (3.2%) had recurrence following remission and two (0.8%) had new moles. Two women (0.8%) died of their disease giving an overall cure of 99%. Only 10 women (4%) experienced grade III/IV toxicity during the first course of treatment and 13 women (5.2%) subsequently. Toxicity included mucositis and stomatitis, pleuritic chest pain, thrombocytopenia, uterine bleeding, abdominal pain, liver function changes, rash and pericardial effusion. A total of 59 women (23.6%) required second-line chemotherapy; 48 women had methotrexate resistance, eight had methotrexate toxicity and an empirical decision to change therapy was made in three. In all, 11 women (4.4%) had a hysterectomy before, during or after treatment; 141 women (56.4%) became pregnant following treatment: in 128 (90.7%), the outcome was successful. Methotrexate with folinic acid rescue is an effective treatment for low-risk persistent trophoblastic disease. It has minimal severe toxicity, excellent cure rates and does not appear to affect fertility.

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Section: Discussionsupporting

confidence: 52%

Low-risk persistent gestational trophoblastic disease treated with low-dose methotrexate: efficacy, acute and long-term effects

et al. 2003

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“…In general, low risk patients are treated with primary single-agent chemotherapy and high risk patients are managed with primary combination chemotherapy. A review of four reports shows 87% remission rate with single-agent chemotherapy and an eventual remission rate of 98.6% (DuBreschter et al, 1987;Dubuc-Lissor et al, 1989;Ayhan et al, 1992;Soper et al, 1994a). Low risk patients who fail first-line chemotherapy with methotrexate in the New England Trophoblastic Center receive MAC (originally methotrexate, 0.3 mg kg -1 i.m., dactinomycin 8-10 µg kg -1 i.v.…”

Section: The American Experiencementioning

confidence: 99%

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et al. 2000

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Summary Persistent gestational trophoblastic disease is potentially fatal, but the majority of patients are cured with chemotherapy. Any developments in treatment are therefore being directed towards maintaining efficacy and reducing toxicity. We evaluated efficacy and toxicity of methotrexate, etoposide and dactinomycin (MEA) as first-line therapy for high risk disease and etoposide and dactinomycin (EA) as second-line therapy for methotrexate-refractory low risk disease in a retrospective analysis of 73 patients (38 MEA, 35 EA) treated since 1986 at a supra-regional centre. The median follow-up period was 5.5 years and the median number of cycles received was 7. The overall complete response rate was 85% (97% for EA, 75% for MEA). Of eight patients who failed to respond, four have since died and four were cured with platinum-based chemotherapy. Alopecia was universal. Grade II or worse nausea, emesis, or stomatitis was observed in 29%, 30% and 37% respectively. Fifty-one per cent experienced grade II/III anaemia, 8% grade II or higher thrombocytopenia and 64% grade III or IV neutropenia; in six cases this was complicated by sepsis. Fifty-four per cent of patients went on to have a normal pregnancy. No patient has developed a second malignancy. In conclusion, the MEA and EA chemotherapy regimens for persistent trophoblastic disease are very well tolerated, do not appear to affect future fertility and are associated with excellent, sustained complete response rates.

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“…Similarly, other authors have reported that primary single-agent chemotherapy induces a complete remission in about 85 to 90 percent of patients with low-or moderate-risk metastatic disease. [77][78][79][80] Vaginal metastases may bleed profusely, requiring local packing, wide excision, or arteriographic embolization of the hypogastric arteries. Thoracotomy may also be performed to excise a site of resistant tumor.…”

Section: Managementmentioning

confidence: 99%

“…However, triple therapy induces a remission in only about half the patients with high-risk metastatic disease. [77][78][79][89][90][91] Treatment with etoposide was demonstrated to be highly effective in the 1980s. Etoposide used as primary therapy induced a complete remission in 56 of 60 patients (93 percent) with nonmetastatic or low-risk metastatic tumors.…”

Section: Selection Of Chemotherapymentioning

confidence: 99%