Treatment of Extremely High Risk and Resistant Gestational Trophoblastic Neoplasia Patients in King Chulalongkorn Memorial Hospital

Oranratanaphan, Shina; Lertkhachonsuk, Ruangsak

doi:10.7314/apjcp.2014.15.2.925

Cited by 10 publications

(5 citation statements)

References 15 publications

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“…According to the accepted guidelines that have a different mechanism of action in selecting agents for combination chemotherapy, etoposide is a useful anticancer agent and has a different mechanism of action to 5-FU and dactinomycin. Moreover, etoposide is included in available chemotherapy regimens for high-risk GTN in vast literatures [ 1 , 27 - 29 ]. Therefore, FAEV combined with intrathecal methotrexate chemotherapy is the first-line chemotherapy for the patients with brain metastases from GTN in PUMCH.…”

Section: Discussionmentioning

confidence: 99%

Management and prognosis of patients with brain metastasis from gestational trophoblastic neoplasia: a 24-year experience in Peking union medical college hospital

et al. 2015

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BackgroundThe optimal treatment for patients with brain metastasis from gestational trophoblastic neoplasia (GTN) has not been established. This study aims to investigate the clinical characteristics and the management of brain metastasis from GTN in relation to patients’ outcomes.MethodsWe retrospectively investigated 109 GTN patients with brain metastasis treated at Peking Union Medical College Hospital from January 1990 to December 2013. Patients mainly received multiagent chemotherapy with florouracil or floxuridine, dactinomycin, etoposide, and vincristine (FAEV) combined with intrathecal methotrexate with or without surgery.ResultsIn the 109 patients, sixty-two (56.1%) patients presented for primary therapy and 47 patients had failed chemotherapy elsewhere. Eight early demise patients who died before or during first cycle of chemotherapy were excluded from analysis. The median follow-up time was 47 months (range 9–180 months). The overall 5-year survival rate (OS) was 71.1%, while the OS rate for patients receiving primary chemotherapy in our hospital was 85.5%, and this fell to 51.9% in patients with failure multidrug chemotherapy elsewhere. Multivariate analysis demonstrated that International Federation of Gynecology and Obstetrics (FIGO) scores over 12 (Hazard ratio-HR 1.279, 95% CI 1.061-1.541, P = 0.010), failure of previous multidrug chemotherapy (HR 3.177, 95% CI 1.277-7.908, P = 0.013), and concurrent renal metastasis (HR 2.654, 95% CI 1.125-6.261, P = 0.026) were the risk factors of overall survival in patients with brain metastases from GTN.ConclusionsPatients with brain metastasis from GTN have favorable outcome by multidrug chemotherapy and adjuvant therapies. Nevertheless, the prognosis is poor if the patients had previous multidrug failure chemotherapy history, concomitant with renal metastasis, or FIGO score over 12. Initial treatment with FAEV combined with intrathecal methotrexate chemotherapy can bring bright prospect to patients with brain metastases from GTN.

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Section: Discussionmentioning

confidence: 99%

Management and prognosis of patients with brain metastasis from gestational trophoblastic neoplasia: a 24-year experience in Peking union medical college hospital

et al. 2015

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“…Several effective regimens of salvage chemotherapy were proposed such as EP/EMA (Bower et al, 1997;Newlands et al, 2000), TP/TE (Wang et al, 2008), and Capecitabine (Bianconi et al, 2007). Some regimens were less effective in a salvage setting such as 5-fluouracil plus Actinomycin D (Manopunya and Suprasert, 2012), and VAC (Oranratanaphan and Lertkhachonsuk, 2014). In some circumstances, hysterectomy may be required…”

Section: Discussionmentioning

confidence: 99%

Human Chorionic Gonadotropin (hCG) Regression Curve for Predicting Response to EMA/CO (Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide and Vincristine) Regimen in Gestational Trophoblastic Neoplasia

Rattanaburi

Boonyapipat²,

Supasinth³

2015

Asian Pacific Journal of Cancer Prevention

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Background: An hCG regression curve has been used to predict the natural history and response to chemotherapy in gestational trophoblastic disease. We constructed hCG regression curves in high-risk gestational trophoblastic neoplasia (GTN) treated with EMA/CO and identified an optimal hCG level to detect EMA/CO resistance in GTN. Materials and Methods: Eighty-one women with GTN treated with EMA/CO were classified as primary high-risk GTN (n = 65) and single agent-resistance GTN (n = 16). The hCG levels prior to each course of chemotherapy were plotted in the 10th, 50th, and 90th percentiles to construct the hCG regression curves. Diagnostic performance was evaluated for an optimal cut-off value. Results: The median hCG levels were 264,482 mIU/mL mIU/mL and 495.5 mIU/mL mIU/mL for primary high-risk GTN and single agent-resistance GTN, respectively. The 50th percentile of the hCG level in primary high-risk GTN and single agent-resistance turned to normal before the 4th and the 2nd course of chemotherapy, respectively. The 90th percentile of the hCG level in primary high-risk GTN and single agent-resistance turned to normal before the 9th and the 2nd course of chemotherapy, respectively. The hCG level of ≥ 118.6 mIU/mL mIU/mL at the 5thcourse of EMA/CO predicted the EMA/CO resistance in primary high-risk GTN patients with a sensitivity of 85.7% and a specificity of 100%. Conclusion: EMA/CO resistance in primary high-risk GTN can be predicted by using an hCG regression curve in combination with the cut-off value of 118.6 mIU/mL at the 5thcourse of chemotherapy.

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“…The treatment modalities include suction dilation and curettage and combination chemotherapy in case of malignancy (Manopunya et al, 2012;Oranratanaphan et al,2014). Invasive mole that follows complete and partial hydatiform mole is characterized with invasion of the molar villi to the myometrium.…”

Section: Introductionmentioning

confidence: 99%

Predictive Role of the Neutrophil Lymphocyte Ratio for Invasion with Gestational Trophoblastic Disease

Güzel¹,

Kokanali²,

Erkılınç³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Treatment of Extremely High Risk and Resistant Gestational Trophoblastic Neoplasia Patients in King Chulalongkorn Memorial Hospital

Cited by 10 publications

References 15 publications

Management and prognosis of patients with brain metastasis from gestational trophoblastic neoplasia: a 24-year experience in Peking union medical college hospital

Management and prognosis of patients with brain metastasis from gestational trophoblastic neoplasia: a 24-year experience in Peking union medical college hospital

Human Chorionic Gonadotropin (hCG) Regression Curve for Predicting Response to EMA/CO (Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide and Vincristine) Regimen in Gestational Trophoblastic Neoplasia

Predictive Role of the Neutrophil Lymphocyte Ratio for Invasion with Gestational Trophoblastic Disease

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