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Gestational trophoblastic neoplasia: treatment outcomes from a single institutional experience

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Abstract

Purpose

To report the outcomes of gestational trophoblastic neoplasia (GTN) at a single institution and to determine the factors affecting response to chemotherapy and survival.

Methods/Patients

From 1979–2010, we retrospectively reviewed the data of 221 patients treated at our center. GTN Patients were assigned to low-risk (score ≤6) or high-risk (score ≥7) based on the WHO risk factor scoring system. Overall survival (OS) probabilities were estimated using Kaplan–Meier method. Logistic regression was applied to study the impact of different factors on the response to initial therapy.

Results

Patients’ OS rate was 97 %. Median age at diagnosis was 37 year. 131 (59 %) patients had low-risk and 88 (40 %) cases had high-risk GTN. Complete remission rates to initial chemotherapy in low-risk group were 53 % and 87 % for single-agent methotrexate or dactinomycin, respectively. In high-risk group, 94 % achieved complete remission to initial chemotherapy with etoposide, methotrexate, dactinomycin, cyclophosphamide, and vincristine (EMA-CO). Etoposide, cisplatin, and dactinomycin as primary therapy in high-risk patients was successful in 70 %, while bleomycin, etoposide, and cisplatin (BEP) was successful in 53 % of cases. Salvage chemotherapy, surgical intervention or radiation therapy resulted in overall complete remission of 90 % in low-risk and 73 % in high-risk groups. Factors associated with resistance to initial chemotherapy were advanced-stage III/IV (p = 0.005), metastatic site other than lung or vagina (p = 0.005) and high-risk prognostic score (p = 0.05). OS was significantly influenced by the type of antecedent pregnancy (molar 98 % vs. others 93 %; p = 0.04), FIGO stage (I, II 100 % vs. III, IV 94 %; p = 0.02), score (low-risk 100 % vs. high-risk 92 %; p = 0.01), and site of metastasis (lung/vagina 98 % vs. others 85 %; p = 0.002).

Conclusions

GTNs have excellent prognosis if properly treated at experienced centers. Single-agent dactinomycin seems more effective for low-risk GTN. EMA-CO remains the preferred primary treatment regimen for high-risk group. The excellent outcome reflects the success of salvage therapy.

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Conflict of interest

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Authors and Affiliations

  1. Medical Oncology Consultant, King Faisal Cancer Center, King Faisal Specialist Hospital & Research Center, P.O. Box 3354, MBC 64, Riyadh, 11211, Saudi Arabia

    H. Al-Husaini, H. Soudy, M. Ahmed, T. Elhassan, A. Omar, S. Al-Hayli, I. Madkhali & I. A. Al-Badawi

  2. Oncology Department, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia

    A. Darwish

  3. National Guard Hospital, Riyadh, Saudi Arabia

    A. Eltigani

  4. Cairo University, Cairo, Egypt

    H. Soudy, M. Ahmed & W. Edesa

  5. Ain Shams University, Cairo, Egypt

    W. Elghamry

  6. Princess Margaret Hospital, Toronto, Canada

    H. Al-Hashem

  7. Florida Hospital Cancer Institute, Orlando, FL, USA

    S. Ahmad

Authors
  1. H. Al-Husaini
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  2. H. Soudy
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  3. A. Darwish
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  4. M. Ahmed
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  5. A. Eltigani
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  6. W. Edesa
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  7. T. Elhassan
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  8. A. Omar
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  9. W. Elghamry
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  10. H. Al-Hashem
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  11. S. Al-Hayli
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  12. I. Madkhali
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  13. S. Ahmad
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  14. I. A. Al-Badawi
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Corresponding author

Correspondence to S. Ahmad.

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Al-Husaini, H., Soudy, H., Darwish, A. et al. Gestational trophoblastic neoplasia: treatment outcomes from a single institutional experience. Clin Transl Oncol 17, 409–415 (2015). https://doi.org/10.1007/s12094-014-1251-1

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  • DOI: https://doi.org/10.1007/s12094-014-1251-1

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