Low‐risk gestational trophoblastic neoplasia – 20 years experience of a state registry

Abstract

BackgroundGestational trophoblastic disease (GTD) is an uncommon but highly treatable condition. There is limited local evidence to guide therapy.AimsTo report the experience of a statewide registry in the treatment of low‐risk gestational trophoblastic neoplasia (GTN) over a 20‐year period.Materials and MethodsA retrospective review of the prospectively maintained GTD registry database was conducted. There were 144 patients identified with low‐risk GTN, of which 115 were analysed. Patient demographics, treatment details and outcomes, including development of resistance, toxicity or relapse were reviewed.ResultsThe incidence of GTD was 2.6/1000 live births. There was 100% survival. The mean time from diagnosis to commencing treatment was 1.9 days (range 0–29 days). Seventy‐seven percent of patients treated with methotrexate achieved complete response. Thirteen patients (11.3%) required multi‐agent chemotherapy, for the treatment of resistant or relapsed disease. There was a higher rate of treatment resistance in those with World Health Organization (WHO) risk scores 5–6 (odds ratio (OR) 6.56, 95% CI 1.73–24.27, P = 0.005) and those with pre‐treatment human chorionic gonadotropin >10 000 (OR 4.00 95% CI 1.73–24.27 P = 0.007). Four patients (3.5%) were diagnosed with choriocarcinoma after commencing treatment. Nine patients (7.8%) had successful surgical treatment for GTN, both alone and in combination with chemotherapy. The relapse rate was 4.3%; all were treated successfully with a combination of chemotherapy and surgery, and 93.9% of patients completed follow up through the registry.ConclusionsMethotrexate is a highly effective treatment for low‐risk GTN, especially with WHO risk score ≤4. The optimal treatment for those with risk scores of 5–6 requires further investigation.

Editor‐in‐Chief's introduction to ANZJOG 64 (3)

“…They found that outcomes were comparable to published international data in terms of completion rate and survival, and that ten-year survival was greater than for those who received intravenous chemotherapy. Also in gynaecological Editorial oncology, McInerny et al 11 present their retrospective review of low-risk gestational trophoblastic neoplasia cases from a prospectively maintained registry. They found good rates of response to methotrexate monotherapy in participants with low World Health Organisation scores but lower rates of success in those with higher scores or higher baseline human chorionic gonadotropin levels.…”