Twenty Years' Experience Of Treating Gestational Trophoblastic Neoplasia In Sweden

Abstract

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.

Hydatidiform mole and subsequent pregnancy outcome: a population-based cohort study

“…In cases of GTN, women are referred for treatment to one of five tertiary referral centers for GTD. It has been estimated that approximately 50% of all Swedish cases of GTN are referred to and treated at Karolinska University Hospital in Stockholm (142). National guidelines for the management of GTD have recently been completed, in order to secure that all GTD patients receive equal treatment and care.…”

Typische Erscheinungsformen des Chorionkarzinoms in der klinischen Praxis - Diagnosestellung und therapeutischer Verlauf bei vier Patientinnen

“…In besonderem Maûe ist dies auf das gute Ansprechen der Chorionkarzinome auf eine Tumorchemotherapie zuru Èckzufu Èhren. Auûerdem sind aufgrund der Erfahrungen in Trophoblasttumorzentren die Kenntnisse u Èber biologische Besonderheiten dieser Erkrankung enorm gewachsen, was nicht zuletzt eine stadiengerechte Behandlung erst ermo Èglicht [6,9,10,12].…”

Gestationsbedingte Trophoblast-Erkrankungen - Ergebnisse der Jahre 1976-1992

“…38 ,5 % aller Pa tien tinnen, die sic h a uc h a us Übe rwe isungen von an deren Einrichtungen re krutiere n. ben ötigten eine Che motherapie . Dies liegt unter den Zahlen ander er Auto ren (12) In der linea ren Regression sanalyse erhö ht sich d ie Mortalitätsra te signifikant. wenn der \VHO-Bisiko-Scor e m ehr als 7 Punkte erg ibt (7).…”

“…Dies entspricht 5.3 % der chemotherapierten GTD und den Angaben in der Literatur. Hezidive, wie au ch bei unseren Patientinn en, tret en üb erw iege nd innerha lb des ersten Jahres a uf (12 ). Dem wi rd mit den entsprechenden Nachsorge protokollen Rechnung getragen (27).…”