The clinical value of imaging with antibody to human chorionic gonadotrophin in the detection of residual choriocarcinoma

Begent, R. H. J.; Bagshawe, K. D.; Green, A. J.; Searle, F.

doi:10.1038/bjc.1987.134

Cited by 28 publications

(4 citation statements)

References 11 publications

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“…A previous report indicated that imaging with antibody directed against hCG can locate deposits of choriocarcinoma and that the method is sensitive and specific enough to be useful clinically (2). We have demonstrated similar clinical value for AI with antibody against aFP in the management of resistant GCT.…”

Section: Case Reportsupporting

confidence: 61%

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Clinical Value of Imaging Using Antibody to Alpha Fetoprotein in Germ Cell Tumours

Hitchins

Begent²,

Green³

et al. 1989

Nuklearmedizin

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Germ cell tumours (GCT) producing alpha fetoprotein (aFP) can be imaged by external scintigraphy after intravenous administration of radiolabelled antibody directed against aFP. Antibody imaging (AI) by this method was used in an attempt to guide surgical resection of deposits of drug-resistant or recurrent GCT. 30 patients with GCT and raised aFP in whom site of tumour was not known were investigated by AI and conventional imaging methods. All but one were heavily pretreated. Where tumour appeared localised, resection was attempted. Tumour was found in all sites positive by both AI and conventional imaging. AI produced false-positive results in one of 30 patients and falsenegative results in 9 patients. Computerised tomography was false-positive in one case and false-negative in three. In these patients, AI gave true-negative and true-positive results, respectively. Of 11 patients with positive AI in whom resection was attempted, 6 achieved sustained complete response with up to 5 years follow-up. We conclude AI and conventional imaging methods to be complementary in selection for surgery of patients with drug-resistant or recurrent GCT.

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Section: Case Reportsupporting

confidence: 61%

“…Recently, we published our experience with AI using antibody against hCG in resistant or recurrent choriocarcinoma (2). In this paper, we report our experience with imaging using antibody directed against aFP in patients with GCT and attempts to define its clinical usefulness.…”

Section: Tumourmentioning

confidence: 99%

Clinical Value of Imaging Using Antibody to Alpha Fetoprotein in Germ Cell Tumours

Hitchins

Begent²,

Green³

et al. 1989

Nuklearmedizin

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“…In contrast, 43% of those patients having a thoracotomy and 71% of those patients having a craniotomy clearly benefited from these surgical procedures. In a number of these patients there are multiple radiological abnormalities still present at the end of chemotherapy and the selection of the anatomical site for surgery can be helped by radioimmunolocalization with anti‐hCG scanning (Begent et al 1987). Even on relapse, the salvage rate with further therapy is still reasonable and 6 (75%) of 8 patients relapsing after EMA/CO therapy have achieved a further sustained remission.…”

Section: Discussionmentioning

confidence: 99%

Results with the EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) regimen in high risk gestational trophoblastic tumours, 1979 to 1989

Newlands

Bagshawe

Begent

et al. 1991

BJOG

167

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Objective— To assess the efficacy, toxicity and survival in patients with high risk GTT treated with the EMA/CO regimen (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine/oncovine). Design— Open non‐randomized study of 148 consecutive patients referred to the Charing Cross Hospital between 1979 and 1989. Setting— Trophoblastic disease centre in a London teaching hospital. Subjects— 148 consecutive patients with high risk GTT were treated with the EMA/CO regimen. 76 patients had received no prior chemotherapy and 72 had received prior chemotherapy. Main outcome measures— Survival, causes of treatment failure and toxicity were analysed. Results— Of 76 patients who had received no prior chemotherapy, 62 (82%) are in remission, 72 patients had received prior chemotherapy and 64 (89%) are in remission; an overall survival of 85% for the 148 patients. Ten of the 76 patients without prior chemotherapy died from extensive disease within 3 weeks of starting chemotherapy. The complete and partial response rates to EMA/CO chemotherapy were 80% and 18% respectively. The addition of cisplatin salvaged 9 of 11 (82%) who developed drug resistance and did not require surgery. Salvage surgery alone resulted in 7 of 8 (87%) having complete remissions. Relapse after EMA/CO chemotherapy is uncommon (5.4%) but survival is still relatively good with further chemotherapy and/or surgery with 6 (75%) of 8 patients obtaining a further sustained remission. Complications from EMA/CO chemotherapy are acceptable with myelosuppression being dose‐limiting. Late sequelae are uncommon: menstruation usually returns with a few months, and no fetal abnormalities have been recorded in subsequent pregnancies. One patient developed what we presume to be a therapy‐induced acute myeloid leukaemia. Conclusion— At present EMA/CO chemotherapy is our treatment of choice for patients with high risk GTT. Its toxicity is predictable and reversible. In patients developing drug resistance, salvage surgery is important. Future developments may include further dose intensification with the addition of haemopoietic growth factors, earlier diagnosis and the separation of gestational from non‐gestational trophoblastic tumours.

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“…At one point during her disease, hCG was undetectable for 4 months but, when chemotherapy again became necessary, the disease proved to be resistant. Finally, she was transferred to the trophoblastic center at the Charing Cross Hospital in London for radioactive anti-hCG detection (18). This investigation showed multiple minimal metastases in the lungs and the bladder.…”

Section: Metastatic High-riskmentioning

confidence: 99%

Twenty Years' Experience Of Treating Gestational Trophoblastic Neoplasia In Sweden

Flam

Lundström

1989

Acta Obstet Gynecol Scand

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Experience gathered during the last 20 years in the treatment of gestational trophoblastic neoplasia (GTN) is presented. Fifty-eight cases were treated at the Karolinska Hospital during the period of 1966-86. This number accounts for approximately 50% of the cases in Sweden during this period of time. Thirty-four patients developed their malignancy after a molar pregnancy. Thirty-three patients were nonmetastatic and of the 25 metastatic cases, 6 patients were staged to a high-risk group. Chemotherapy was given to all patients except one who had a primary choriocarcinoma in an ectopic pregnancy. Surgery was performed in elective cases or when chemotherapy failed. Surgical procedures were also performed in a few emergency situations. Since 1978 all patients were started on methotrexate--folinic acid ad modum Goldstein. When this medication failed, either the CHAMOMA (vincristine, methotrexate--folinic acid, actinomycin D, melphalan, adriamycin) or later the EMA/CA (etoposide, methotrexate--folinic acid, actinomycin D, cyclophosphamide, adriamycin) regimen ad modum Bagshawe was given. An overall remission rate of 96.5% was achieved. The minimum period of follow-up was 2 years. The 2 patients who died (in 1966 and 1982) were referred to our department in a late stage. Five patients had a late recurrence and all but one were successfully treated.

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The clinical value of imaging with antibody to human chorionic gonadotrophin in the detection of residual choriocarcinoma

Cited by 28 publications

References 11 publications

Clinical Value of Imaging Using Antibody to Alpha Fetoprotein in Germ Cell Tumours

Clinical Value of Imaging Using Antibody to Alpha Fetoprotein in Germ Cell Tumours

Results with the EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) regimen in high risk gestational trophoblastic tumours, 1979 to 1989

Twenty Years' Experience Of Treating Gestational Trophoblastic Neoplasia In Sweden

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