Share This Article:

Chemo-resistant gestational trophoblastic neoplasia, 5-years experience of Mansoura University Hospital, Egypt

Abstract Full-Text HTML Download Download as PDF (Size:157KB) PP. 153-157
DOI: 10.4236/ojog.2011.13029    4,767 Downloads   8,324 Views   Citations

ABSTRACT

Introduction: Gestational trophoblastic neoplasia (GTN), is recognized as the most curable gynaecologic malignancy. However, many cases are resistant to first line chemotherapy. Objective: The aim of the study is to report our 5 years experience in the management of GTN cases with special stress on the chemo-resistant cases. Methods: The study was performed through reviewing the records of 51 patients who were diagnosed as GTN during the period from 1/1/2006 to 31/12/2010 in Mansoura University Hospital, Egypt. Results: Resistance to methotrexate therapy was reported in 15.15% of low risk cases and received etoposide or cisplatinum/etoposide. Sixty percent of high risk cases were resistant to MAC combination and received salvage chemotherapy or hysterectomy. There was significant correlation between patient response and initial B-hCG, as well as WHO risk score (P value = 0.001 in both) but correlations with age, parity, type of antecedent pregnancy, and histopathology were non significant (p = 0.95, 0.53, 0.47& 0.83 respectively). Conclusion: Low risk GTN cases who were resistant to methotrexate monotherapy received etoposide or cisplatinum/etoposide as a second-line therapy. High risk GTN cases who were resistant to MAC combination received second-line combination chemotherapy and/or hysterectomy. WHO risk score and initial B-hCG were correlated to resistance to first line chemotherapy.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Hemida, R. , Toson, E. , Shalaby, H. , Refaie, E. and Eldin, D. (2011) Chemo-resistant gestational trophoblastic neoplasia, 5-years experience of Mansoura University Hospital, Egypt. Open Journal of Obstetrics and Gynecology, 1, 153-157. doi: 10.4236/ojog.2011.13029.

References

[1] Disaia, P.J. and Creasman, W.T. (2007) Gestational trophoblastic neoplasia, 7th Edition. Clinical Gynaecologic Oncology, Mosby Inc, I, 201-233.
[2] Berkowitz, R.S. and Goldstein, D.P. (2009) Current management of gestational trophoblastic diseases. Gynecologic Oncology, 112, 654-662. doi:10.1016/j.ygyno.2008.09.005
[3] Moodley, M., Tunkyi, K. and Moodley J. (2003) Gestational trophoblastic syndrome: An audit of 112 patients. A South African experience. International Journal of Gynecological Cancer, 13, 234-239.
[4] Bagshawe, K.D., Dent, J., Newlands, E.S., Begent, R.H.J. and Rustin, G.J.S. (1989) The role of low-dose methotrexate and folinic acid in gestational trophoblastic tumors. British Journal of Obstetrics and Gynecology, 96, 795-802. doi:10.1111/j.1471-0528.1989.tb03318.x
[5] Homesley, H.D., Blessing, J.A., Rottenmaier, M., Capizzi, R.L., Major, F.J. and Twiggs, L.B. (1988) Weekly intramuscular methotrexate for nonmetastatic gestational trophoblastic disease. Obstetrics and Gynecology, 72, 413-418.
[6] McNeish, I.A., Strickland, S., Holden, L., et al. (2002) Low-risk persistent gestational trophoblastic disease: Out-come after initial treatment with low-dose methotrexate and folinic acid from 1992-2000. Journal of Clinical Oncology, 20, 1838-1844. doi:10.1200/JCO.2002.07.166
[7] Bower, M., Newlands, E.S., Holden, L., et al. (1997) EMA/CO for high-risk gestational trophoblastic tumours: Results from a cohort of 272 patients. Journal of Clinical Oncology, 15, 2636-2643.
[8] Newlands, E.S., Mulholland, P.J. and Holden, l., et al. (2000) Etoposide and cisplatin/etoposide, methotrexate, and actinomycin D (EMA) chemotherapy for patients with high-risk gestational trophoblastic tumors refractory to EMA/cyclophosphamide and vincristine chemotherapy and patients presenting with metastatic placental site trophoblastic tumors. Journal of Clinical Oncology, 18, 854-859.
[9] El-Lamie, I.K., El Sayed, H.M., Badawie, A.G., Bayomi, W.A., El-Ghazaly, H.A., Khalaf-Allah, A.E., HEl-Mahallawy, M.N. and El-Lamie, K.I. (2006) Evolution of treatment of high-risk metastatic gestational trophoblastic tumors: Ain shams university experience. International Journal of Gynecological Cancer, 16, 866-874.
[10] Deng, L., Yan, X., Zhang, J. and Wu, T. (2009) Combination chemotherapy for high-risk gestational trophoblastic tumour. Cochrane Database of System Reviews, 15, CD-005196.
[11] Patel, S.M. and Desai, A. (2010) Management of drug resistant gestational trophoblastic neoplasia. The Journal of Reproductive Medicine, 55, 296-300.
[12] Zhou, Y., Feng, F.Z., Xiang, Y. and Wan, X.R. (2010) Clinical analysis of patients with relapsed and chemoresistant gestational trophoblastic neoplasia. Chinese Journal of Obstertrics and Gynecology, 45, 804-807.
[13] Ngan, S. and Seckl, M.J. (2007) Gestational trophoblastic neoplasia management: An update. Current Opinion in Oncology, 19, 486-491. doi:10.1097/CCO.0b013e3282dc94e5
[14] Kaye, D.K. (2002) Gestational trophoblastic disease following complete hydatidiform modle in Mulago Hospital, Kampala, Uganda. African Health Science, 2, 47-51.
[15] Sebire, N.J. and Seckl, M.J. (2008) Gestational trophoblastic disease: Current management of hydatidiform mole. British Medicine Journal, 337, 1193. doi:10.1136/bmj.a1193
[16] Kuyumcuoglu, U., Guzel, A., Erdemoglu, M. and Celik Y. (2011) Risk factors for persistent gestational trophoblastic neoplasia. Journal of Experimental Therapeutics and Oncology, 9, 81-84.
[17] Pongsaranantakul, S. and Kietpeerakool, C. (2009) Hysterectomy in gestational trophoblastic neoplasia: Chiang mai university hospital experience. Asian Pacific Journal of Cancer Prevention, 10, 311-314.
[18] Sebire, N.J. and Lindsay, I. (2010) Current Issues in the histopathology of gestational trophoblastic tumors. Fetal and Pediatric Pathology, 29, 30-44. doi:10.3109/15513810903266120
[19] Kumar, J., Ilancheran, A. and Ratnam, S. (1988) Pulmonary metastases in gestational trophoblastic disease: A review of 97 cases. British Journal of Obstetrics and Gynaecology, 95, 70-74. doi:10.1111/j.1471-0528.1988.tb06482.x
[20] Bagshawe, K.D. (1976) Risk and prognostic factors in trophoblastic neoplasia. Cancer, 38, 1373-1385. doi:10.1002/1097-0142(197609)38:3<1373::AID-CNCR2820380342>3.0.CO;2-E
[21] Deligdisch, L., Driscoll, S.G. and Goldstein, D.P. (1978) Gestational trophoblastic neoplasms: Morphologic correlates of therapeutic response. American Journal of Obstetrics and Gynecology, 130, 801-806.
[22] Wang, J., Short, D., Sebire, N., Lindsay, I., Newlands, E., Schmid, P., Savage, P. and Seckl, M. (2008) Salvage chemotherapy of relapsed or high-risk gestational trophoblastic neoplasia (GTN) with paclitaxel/cisplatin alternating with paclitaxel/etoposide (TP/TE). Annals of Oncology, 19, 1578-1583. doi:10.1093/annonc/mdn181
[23] Fulop, V., Szigetvri, I., Szepesi, J., Torok, M. and Berkowitz, R.S. (2008) Diagnosis and treatment of high-risk metastatic gestational trophoblastic neoplasia in Hungary. Journal of Reproductive Medicine, 53, 541-546.

  
comments powered by Disqus

Copyright © 2019 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.