Retrospective Analysis of Gestational Trophoblastic Neoplasia: Single Center Experience

Abstract

This study aims to analyze the clinicopathologic characteristics and treatment outcomes of our patients with gestational trophoblastic neoplasia (GTN) and to present our real-life experience. A total of 32 patients with GTN diagnosed according to the FIGO 2002 criteria followed in Zekai Tahir Burak Women's Health Training and Research Hospital between 2011-2018 were included. Demographic features, treatment outcomes, and survival were analyzed retrospectively. The median follow up time was 32.1 (3.3-76.9) months. Of the 32 patients, 27 (84.4%) were defined as low-risk GTN (risk score < 7) and 5 (15.6%) were high-risk GTN (risk score ≥ 7) according to the FIGO risk score. Seventeen (62.9%) patients with low-risk GTN achieved complete remission (CR) with single agent MTX. CR rate was 60% (12/20) in patients receiving weekly MTX and 71.4% (5/7) in MTX-FA eight-day regimen (p= 0.590). Of the 9 MTX resistant patients, 8 (88.8%) achieved CR with second-line Actinomycin D (ActD). Three (60%) out of the five high-risk GTN patients acquired CR with first-line EMA-CO (etoposide, MTX, plus ActD alternating with cyclophosphamide and vincristine). In the follow-up period one patient (3.1%) had recurrent disease. By the data cut off date, all of the patients were alive and CR could not be achieved in one (3.1%) patient. All patients with low-risk GTN achieved CR with sequential therapies ultimately. Therefore, single agent MTX is a reasonable option in the initial treatment of low-risk GTN. Moreover, Actinomycin D is highly effective in patients with low-risk GTN who are resistant to MTX.