Prognosis of patients with relapsed and chemoresistant gestational trophoblastic neoplasia transferred to the Peking Union Medical College Hospital

Feng, Fenling; Xiang, Yang; Wan, Xirun; Zhou, Yu

doi:10.1111/j.1471-0528.2009.02420.x

Cited by 14 publications

(12 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Two different investigations of patients with GTN who were treated at trophoblastic disease centers revealed recurrence rates of 3.5% and 4.7%. 4,5 Previous studies showed that patients with recurrent GTN had better outcomes than those with primary chemoresistant disease 6,7 ; the survival rates of patients with recurrent GTN were 77.8% and 93% in two previous studies. 6,8 However, the chemotherapy regimen that is most effective for patients with recurrent GTN remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Management and risk factors of recurrent gestational trophoblastic neoplasia: An update from 2004 to 2017

et al. 2020

View full text Add to dashboard Cite

Objective We investigated the clinical characteristics, treatments, and survival of patients with gestational trophoblastic neoplasia (GTN) who experienced recurrence. Factors predictive of recurrence were also investigated. Methods Patients with GTN who recurred after completing chemotherapy at Peking Union Medical College Hospital Trophoblastic Disease Center were identified between January 2004 and December 2017. Logistic regression analysis was used to identify factors predictive of GTN recurrence. Results A total of 1827 patients with GTN achieved complete remission (CR) at our center, of whom 118 (6.5%) experienced recurrence during follow‐up. The recurrence rates for patients initially treated at our center and those referred to us were 2.7% and 14.6%, respectively. The majority of recurrent patients received floxuridine‐based multiagent chemotherapy (n = 64). Patients who underwent surgery achieved a significantly higher CR rate than those who did not (88.6% vs 61.1%, P = .001). Although 94.1% of recurrent patients reachieved CR, 33.3% of them recurred for a second time. The 5‐year survival rate of the entire cohort was 80.4%. An interval between antecedent pregnancy and chemotherapy >12 months (OR: 6.600, 95% CI [3.217‐13.540], P < .001), and an interval from first chemotherapy to achieving β‐human chorionic gonadotropin (β‐hCG) normalization >14 weeks (OR: 2.226, 95% CI [1.080‐4.588], P = .030) were predictors of recurrence. Conclusions Patients with recurrent GTN are prone to recurring for a second time. Surgery plays a beneficial role in the management of recurrent GTN. An interval between antecedent pregnancy and chemotherapy >12 months, and an interval from first chemotherapy to achieving β‐hCG normalization >14 weeks were predictors of recurrence.

show abstract

Section: Introductionmentioning

confidence: 99%

Management and risk factors of recurrent gestational trophoblastic neoplasia: An update from 2004 to 2017

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Chemoresistant case is when the patient had a plateau (<50% fall in the -hCG levels) or an increased -hCG level and/or development of new metastases for at least two consecutive cycles of combined chemotherapy. 13 EMACO has the best effectiveness-to-toxicity ratio, hence making it the first line regiment of combination chemotherapy. 14 Patients with disease resistant to EMACO can be treated using EMAEP, a regimen that substitutes cyclophosphamide and vincristine on day 8 with cisplatin and etoposide.…”

Section: Discussionmentioning

confidence: 99%

Uterine Perforation on Invasive Hydatidiform Mole during EMACO Treatment

Pradipta

Andrijono²,

Purbadi³

et al. 2016

Indones J Obstet Gynecol

View full text Add to dashboard Cite

Objective: Improving skill and knowledge to recognize and manage a rare case of uterine perforation on invasive hydatidiform mole. Method: Case report. Result: A 42 years old Indonesian woman, Parity 2 Abortus 2 with history of 2 c-sections and 2 curettage, came with chief complaint of recurrent vaginal bleeding since 4 months before admission. Patient had a history of previous curettage with indication of hydatidiform mole and recurrent bleeding with no histopathology results. On examination we found a vesicular mass with infiltration, destroying the right-front uterine corpus, size 8x6 cm with an internal echo mass. Chest x-ray showed multiple nodules in the lung. The patient, considered as low risk Gestational Trophoblastic Neoplasia patient with FIGO Score of 6, underwent chemotherapy with 2 series of methotrexate . Due to the non-declining level of -hCG, the regimen was added with EMACO. In the process of chemotherapy, the pa-tient’s-hCG declined but then she complained of major abdominal pain. Exploratory laparotomy was performed and we found a mass sized 5x5x5 cm on the right side of the uterus at the broad ligament with a rupture at the posterior part of the mass sized 0.5x0.5 cm. Upon incision of the uterus, we found a mass from the right side protruding to the isthmus of the uterus. Histopathology showed necrosis, blood and chorionic villi in myometrium corresponding to invasive mole. Patient was then given another 5 series of EMACO and her condition was unremarkable during the remaining course of treatment. Conclusion: Invasive mole treatment is determined based on the risk factors. Uterine perforation still occurred in this case regardless of the decreasing hCG level during EMACO treatment. It emphasizes the importance of clinical examination as chemotherapy responsiveness. Long-term treatment can have a good prognosis but good collaboration between the gynecologist and the patient is essential. [Indones J Obstet Gynecol 2014; 3: 162-165] Keywords: EMACO, invasive mole, perforation

show abstract

“…The prognosis for patients with chemoresistant GTN is worse than for those with relapsed GTN[7]. In a series of 81 patients, the long-term serologic complete remission rate reported was 52.6 % in chemoresistant GTN and 76.7 % in relapsed GTN [8]. …”

Section: Chemoresistant Gestational Trophoblastic Diseasementioning

confidence: 99%

Management of Chemoresistant and Quiescent Gestational Trophoblastic Disease

Ngu

Chan

2014

Curr Obstet Gynecol Rep

View full text Add to dashboard Cite

Gestational trophoblastic neoplasia (GTN) is highly chemosensitive and has a high cure rate. Since the introduction of chemotherapy, reliable measurement of human chorionic gonadotropin (hCG) levels, and individualised risk-based therapy into the management of GTN, almost all low-risk and more than 80 % of high-risk GTN cases are curable. However, approximately 25 % of high-risk GTN developed resistance to chemotherapy or relapsed after completion of initial therapy, which often necessitate salvage combination chemotherapy. On the other end of the spectrum, a proportion of patients with gestational trophoblastic disease (GTD) have persistently low levels of hCG, without clinical or radiological evidence of disease, a condition called quiescent GTD. Recently, measurement of hyperglycosylated hCG has been proposed for the management of patients with quiescent GTD. Although representing a small proportion of GTD cases, the management of patients with chemoresistant and quiescent GTD often poses challenges to medical practitioners.

show abstract

Prognosis of patients with relapsed and chemoresistant gestational trophoblastic neoplasia transferred to the Peking Union Medical College Hospital

Cited by 14 publications

References 16 publications

Management and risk factors of recurrent gestational trophoblastic neoplasia: An update from 2004 to 2017

Management and risk factors of recurrent gestational trophoblastic neoplasia: An update from 2004 to 2017

Uterine Perforation on Invasive Hydatidiform Mole during EMACO Treatment

Management of Chemoresistant and Quiescent Gestational Trophoblastic Disease

Contact Info

Product

Resources

About