Gestational Trophoblastic Disease - Experience of the Sheffield (United-Kingdom) Supraregional Screening and Treatment Service

Sheridan, Elizabeth; Hancock, B. W.; Smith, Selma; Dorreen, M.; Neal, F. E.; Pennington, G. W.; Millar, David

doi:10.3892/ijo.3.2.149

Cited by 11 publications

(15 citation statements)

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“…Overall, 20% of low-risk disease patients initially treated with single-agent methotrexate chemotherapy develop resistance, but in our experience all such patients can be cured with salvage chemotherapy (Sheridan et al, 1993). In this series all patients had low-risk disease and all achieved complete remission.…”

Section: Discussionmentioning

confidence: 67%

“…The chemotherapy policy (Table 1), including the use of repeat uterine evacuation -which leads to disease resolution in up to three-quarters of patients in whom this is performed, has enabled us to expose only 5% of patients registered in our centre to cytotoxic chemotherapy, whilst reporting very high overall cure rates (Sheridan et al, 1993;Hancock, 1997). In the USA, the mobility of the population and medico-legal factors result in less stringent criteria being used -women with βhCG not regressing to normal in 4-6 weeks receive chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…The patient is assigned to a risk group (Sheridan et al, 1993) based on the Charing Cross Prognostic Scoring System (Bagshawe, 1976). Patients with low risk (score ≤ 7) receive lowdose methotrexate as the first-line chemotherapy (methotrexate 50 mg intramuscular (i.m.)…”

Section: Methodsmentioning

confidence: 99%

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Treatment of persistent trophoblastic disease later than 6 months after diagnosis of molar pregnancy

Gillespie

Kumar

Hancock³

2000

Br J Cancer

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Of 4257 patients with gestational trophoblastic disease (GTD) registered between 1986 and 1996 with the Trophoblastic Screening and Treatment Centre, Sheffield, 231 women required chemotherapy; 28 were treated 24 weeks or more after the initial evacuation of products of conception. In 18 patients late treatment was a result of a predetermined watch and wait policy on the part of the Centre; these patients formed the study group. Patients were identified from the Centre's computer database. The time interval from first evacuation (diagnosis) to start of chemotherapy was calculated for each patient. Hospital records were reviewed when the interval of observation was 24 weeks or greater to determine patient characteristics, treatment and outcome. Eighteen women were treated ‘late’ (according to Centre policy), with a median age of 30 years (range 21–57 years). The interval from diagnosis to treatment ranged from 24 to, in one case, 56 weeks (median 33 weeks). Fourteen of 18 women had complete moles, 3/18 had partial moles and one had unclassified disease. All women had low-risk disease and were treated with single-agent methotrexate; 17 were cured with this regimen, one also required salvage chemotherapy. In conclusion, where a successful surveillance programme is in operation for GTD, a wait and watch policy can be adopted without compromising patients whose definitive treatment is commenced more than 6 months after the initial diagnosis. © 2000 Cancer Research Campaign

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

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Treatment of persistent trophoblastic disease later than 6 months after diagnosis of molar pregnancy

Gillespie

Kumar

Hancock³

2000

Br J Cancer

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“…In Sheffield, there are around 400 patients registered annually with a molar pregnancy. Most patients have no further problems following evacuation of the mole, but about 5% require chemotherapy for persistent disease (Sheridan et al, 1993).…”

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confidence: 99%

Low-risk persistent gestational trophoblastic disease treated with low-dose methotrexate: efficacy, acute and long-term effects

et al. 2003

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The aim of this study was to evaluate the efficacy and toxicity of low-dose methotrexate with folinic acid rescue in a large series of consecutively treated patients with low-risk persistent gestational trophoblastic disease. Between January 1987 and December 2000, 250 patients were treated with intramuscular methotrexate (50 mg on alternate days 1, 3, 5, 7) with folinic acid (7.5 mg orally on alternate days 2, 4, 6, 8) rescue. The overall complete response rate without recurrence was 72% for first-line treatment and 95% for those who required second-line chemotherapy. Eight women (3.2%) had recurrence following remission and two (0.8%) had new moles. Two women (0.8%) died of their disease giving an overall cure of 99%. Only 10 women (4%) experienced grade III/IV toxicity during the first course of treatment and 13 women (5.2%) subsequently. Toxicity included mucositis and stomatitis, pleuritic chest pain, thrombocytopenia, uterine bleeding, abdominal pain, liver function changes, rash and pericardial effusion. A total of 59 women (23.6%) required second-line chemotherapy; 48 women had methotrexate resistance, eight had methotrexate toxicity and an empirical decision to change therapy was made in three. In all, 11 women (4.4%) had a hysterectomy before, during or after treatment; 141 women (56.4%) became pregnant following treatment: in 128 (90.7%), the outcome was successful. Methotrexate with folinic acid rescue is an effective treatment for low-risk persistent trophoblastic disease. It has minimal severe toxicity, excellent cure rates and does not appear to affect fertility.

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“…The most common side-effects of treatment are conjunctivitis and oral mucositis, which are usually ameliorated with appropriate therapy. However, approximately 20% of patients (Sheridan et al, 1993) experience the potentially disabling side-effects of pleuritic chest pain and dyspnoea. If severe, this can lead to the discontinuation of methotrexate therapy and alteration of treatment to other chemotherapeutic agents.…”

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confidence: 99%

Pulmonary function in patients with trophoblastic disease treated with low-dose methotrexate

Gillespie

Lorigan²,

Radstone³

et al. 1997

Br J Cancer

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Summary The Sheffield Trophoblastic Disease Centre treats about 25 patients with persistent trophoblastic disease each year. A total of 75% of patients are classified as low risk according to the Charing Cross Hospital prognostic scoring system and receive methotrexate (MTX) 50 mg, i.m., on days 1, 3, 5, 7 with folinic acid 7.5 mg orally 24 h after each methotrexate injection. There is a 7-day rest between treatment cycles. Remission is achieved in 85% of cases. Approximately 20% of patients experienced pleuritic chest pain and dyspnoea. We have evaluated prospectively lung function in 16 low-risk patients receiving methotrexate. All patients had pulmonary function tests [spirometryforced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), peak expiratory flow rate (PEFR), and transfer factor -TLCO, kCO] performed before and after completed treatment. A mean of 7.5 cycles of MTX were administered (range 4-11). There was a significant reduction in the mean TLCO (mean pre/post 8.15/7.38 mmol min-' kPa-1, P = 0.01), but there were no other statistically significant changes. Three patients experienced respiratory symptoms and were found to have a 39%, 28%, and 11 % reduction in TLCO from baseline, improving on follow up to pretreatment levels. Low-dose MTX is an effective therapy but may cause troublesome pulmonary toxicity.

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Gestational Trophoblastic Disease - Experience of the Sheffield (United-Kingdom) Supraregional Screening and Treatment Service

Cited by 11 publications

References 0 publications

Treatment of persistent trophoblastic disease later than 6 months after diagnosis of molar pregnancy

Treatment of persistent trophoblastic disease later than 6 months after diagnosis of molar pregnancy

Low-risk persistent gestational trophoblastic disease treated with low-dose methotrexate: efficacy, acute and long-term effects

Pulmonary function in patients with trophoblastic disease treated with low-dose methotrexate

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