Document Detail


High-risk gestational trophoblastic neoplasia at Gujarat Cancer and Research Institute: thirteen years of experience.
MedLine Citation:
PMID:  20795348     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To evaluate and analyze the results of chemotherapy (EMA-CO [etoposide, methotrexate, actinomycin D-cyclophosphamide, vincristine]) in high-risk gestational trophoblastic neoplasia (GTN). STUDY DESIGN: A total of 97 women with high-risk GTN were evaluated for a period of 13 years (1995-2008). All women received EMA-CO as a first-line chemotherapy. EMA-EP (etoposide, methotrexate, actinomycin and cisplatinum), PVB (cisplatin, vinblastine and bleomycin), and BEP (bleomycin, etoposide and cisplatin) were the chemotherapies used as second-line therapy in women who experienced resistance to primary chemotherapy. Intrathecal methotrexate was given in women with brain metastasis and also as prophylaxis in pulmonary metastasis. Eleven women had brain metastasis and received cranial radiotherapy. The most common toxicity was hematologic. . RESULTS: Of 97 women, 78 (80.4%) were evaluable and 19 (19.6%) were lost to follow-up with incomplete treatment. Of the 78 patients, 6 women developed resistance and had progression of disease. Seven women had died (5 due to disease, 2 due to chemotherapy toxicity). Overall 65 of the 78 (83.3%) women achieved remission. Of the 78 women, 66.7% (52/78) had complete remission with first-line chemotherapy, and an additional 16.6% (13/78) achieved remission with second-line chemotherapy, resulting in a total of 83.3% (65/78) attaining remission. A total of 46% (30/ 65) had follow-up of > 3 years, and 32.4% (21/65) had follow-up of 1-3 years. Three of 9 women with brain metastasis achieved remission. Sixty percent (39/65) resumed normal menstrual function (had remission for at least 2 years). Twelve women became pregnant since the completion of the chemotherapy, with 10 live births of healthy infants without any congenital abnormalities. CONCLUSION: High-risk GTNs are highly curable if properly treated, and patients can anticipate a normal future reproductive outcome. EMA-CO remains the preferred chemotherapy for management.
Authors:
Anjana Chauhan; Kalpana Dave; Ava Desai; Meeta Mankad; Shilpa Patel; Pariseema Dave
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of reproductive medicine     Volume:  55     ISSN:  0024-7758     ISO Abbreviation:  J Reprod Med     Publication Date:    2010 Jul-Aug
Date Detail:
Created Date:  2010-08-27     Completed Date:  2010-09-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0173343     Medline TA:  J Reprod Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  333-40     Citation Subset:  IM    
Affiliation:
Gujarat Cancer and Research Institute, Regional Tertiary Cancer Center, B. J. Medical College Campus, Aswara, Ahmedabad, Gujarat, India. dranjuc@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Antineoplastic Combined Chemotherapy Protocols / therapeutic use
Bleomycin / therapeutic use
Cisplatin / therapeutic use
Cyclophosphamide / therapeutic use
Dactinomycin / therapeutic use
Drug Resistance, Neoplasm
Etoposide / therapeutic use
Female
Gestational Trophoblastic Neoplasms / drug therapy*,  mortality*,  pathology
Humans
India
Methotrexate / therapeutic use
Neoplasm Metastasis
Pregnancy
Remission Induction
Retrospective Studies
Uterine Neoplasms / drug therapy*,  mortality*,  pathology
Vinblastine / therapeutic use
Vincristine / therapeutic use
Chemical
Reg. No./Substance:
0/BEP protocol; 0/EMA-CO protocol; 0/PVB protocol; 11056-06-7/Bleomycin; 15663-27-1/Cisplatin; 33419-42-0/Etoposide; 50-18-0/Cyclophosphamide; 50-76-0/Dactinomycin; 57-22-7/Vincristine; 59-05-2/Methotrexate; 865-21-4/Vinblastine

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