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The roles of surgery and EMA/CO chemotherapy regimen in primary refractory and non-refractory gestational trophoblastic neoplasia

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Abstract

Purpose

To determine the characteristics and outcome of patients with refractory gestational trophoblastic neoplasia (GTN) after primary chemotherapy (CTx).

Methods

The outcome of low- and high-risk patients with refractory GTN (n = 14, 37%) was compared to those with non-refractory GTN (n = 24, 63%). Methotrexate treatment was used for patients with low-risk disease and EMA/CO for patients with high-risk disease.

Results

Median follow-up time was 53 months (range 1–173 months). All non-refractory patients and 11 refractory patients (79%) survived (p = 0.015). Factors related to resistance to primary CTx was age (p = 0.012), duration between causal pregnancy and initial treatment (p = 0.003), surgery (p = 0.014), hCG level before CTx (p = 0.09) and half-life of hCG (p = 0.061). Six out of 10 low-risk refractory patients treated with EMA/CO regimen in the second-line setting had been followed by no evidence of disease. Nine of 38 (24%) patients underwent surgery (TAH ± BSO) for GTN. All of the patients treated with surgery were in the non-refractory group, but none of refractory patients underwent surgery (p = 0.014).

Conclusions

Surgery and EMA/CO regimen are one of the main factors that play a role in the management of refractory low-risk GTN.

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Conflict of interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Medical Oncology, Oncology Institute, Istanbul University, Capa, 34093, Istanbul, Turkey

    Adnan Aydiner, Serkan Keskin, Faruk Tas & Erkan Topuz

  2. Department of Gynecologic Oncology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey

    Sinan Berkman & Ergin Bengisu

  3. Department of Pathology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey

    Huseyin Ridvan İlhan

Authors
  1. Adnan Aydiner
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  2. Serkan Keskin
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  3. Sinan Berkman
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  4. Ergin Bengisu
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  5. Huseyin Ridvan İlhan
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  6. Faruk Tas
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  7. Erkan Topuz
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Correspondence to Serkan Keskin.

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Aydiner, A., Keskin, S., Berkman, S. et al. The roles of surgery and EMA/CO chemotherapy regimen in primary refractory and non-refractory gestational trophoblastic neoplasia. J Cancer Res Clin Oncol 138, 971–977 (2012). https://doi.org/10.1007/s00432-012-1173-7

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  • DOI: https://doi.org/10.1007/s00432-012-1173-7

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