Gestational trophoblastic neoplasia: A 6 year retrospective study

Abstract

Aims and Objectives:To study the clinical presentations of gestational trophoblastic neoplasia and its response to chemotherapy.Materials and Methods:This is a retrospective study of 28 women of gestational trophoblastic neoplasia evaluated over a period of 6 years from January 2004 to December 2009. Patients were evaluated on the basis of their age, number of deliveries, history of abortion or molar pregnancy, and the treatment received. All patients were scored on the basis of WHO scoring system. Patients with low risk (score </=6) received single agent chemotherapy with methotrexate or actinomycin D. Patients with high risk (score >/=7) received multiple agent chemotherapy with EMACO regimen. After completion of chemotherapy patients were followed for a minimum of 2 years. The response to treatment was evaluated during follow-up by clinical examination, beta hCG levels and imaging as and when required.Results:Out of 28 women only 27 could be evaluated, because 1 patient was lost to follow-up. Out of 27 patients, 18 patients (66.67%) achieved complete remission with the first-line chemotherapy and additional 25.92% (7/27) achieved complete remission with second line chemotherapy resulting in complete remission of 92.5% (25/27).Conclusion:Gestational trophoblastic neoplasia is curable if patient is properly evaluated and scored. It shows good response to chemotherapy.

Trends of Gestational Trophoblastic Disease at a Tertiary Care Hospital

“…Two high risk GTN patients treated with EMA-CO achieved remission with four and eight cycles of chemotherapy each. This is comparable with a study conducted by Shivastava et al 19 where the low risk patients treated with MTX achieved remission after one cycle, those who were treated with Act-D achieved remission after three cycles and in high risk patients treated with EMA-CO, ten patients achieved remission after three cycles and six patients achieved remission after six cycles.…”

“…However, different studies reported 71% (Escobar et al), 27 87.7% (Bafna et al) 28 and 89.4% (Shrivastava et al) 19 which could be due to the presence of widespread metastatic disease in their patients.…”

“…Shrivastava 19 reported TAH in seven patients of low risk and two in high risk patients for different reasons. May et al 2 reported 32 patients with low risk GTN treated with hysterectomy and chemotherapy.…”

“…Under high risk group, one was 25 years and another 50 years age. (Figure 1) In a study conducted by Shrivastava et al, 19 eight out of 27 (29.6%) were aged above 40 years and all were scored as high risk GTN. All low risk cases were aged below 40 years.…”

FIGO stage IV gestational choriocarcinoma misdiagnosed as pulmonary tuberculosis: A case report

“…Transvaginal sonogram and sonohysterography examination were also performed, however the results were unremarkable. Following a consultation, gestational choriocarcinoma with pulmonary and cerebral metastasis [FIGO stage IV; World Health Organization score, 15 (8)] was diagnosed, which had been misdiagnosed as pulmonary tuberculosis previously at the local hospital. After written informed consent was obtained, systemic multi-agent chemotherapy was administered (Table I).…”