TREATMENT OUTCOMES OF GESTATIONAL TROPHOBLASTIC DISEASE, EXPERIENCE FROM SAUDI ARABIA
DOI:
https://doi.org/10.55519/JAMC-02-12695Keywords:
Gestational trophoblastic neoplasia, gestational trophoblastic disease, methotrexate, chemotherapyAbstract
Background: This research aims to assess the treatment outcomes and chemotherapy duration required for the normalization of Human chorionic gonadotropin (HCG) levels in patients diagnosed with Gestational Trophoblastic Neoplasia (GTN), encompassing both benign and malignant forms of the condition. Methods: This retrospective study included GTD patients treated with chemotherapy in a single oncology clinic from January 2016 to May 2022. Clinical data were gathered from electronic records of the patients. Results: During the study period, a total of 24 patients diagnosed with GTD underwent chemotherapy, with a median age of 32 years (range: 18–51). Intramuscular Methotrexate was the primary single-agent chemotherapy utilized in 20 cases (83%) for low-risk disease, while the EMA-CO regimen was the predominant combination chemotherapy employed in 3 cases (13%) for high-risk disease. The median number of chemotherapy cycles administered was 2 (range: 1–16), with a median duration of 4 weeks (range: 1–16) required for Human chorionic gonadotropin (HCG) normalization. Approximately half of the patients (n=10, 47.5%) transitioned to second-line combination chemotherapy, with a median normalization duration of 4 months. Four patients (40%) subsequently received third-line combination chemotherapy using the EMA-CO regimen. Initial complete response was achieved in 11 patients (47%) with first-line treatment, while 10 patients (43%) required second-line chemotherapy and 4 patients (17%) necessitated third-line EMACO chemotherapy. Of the 24 patients, 22 achieved complete response, while 2 patients are currently undergoing treatment. Conclusion: All patients successfully attained complete response with chemotherapy. The median duration of chemotherapy for achieving normalization of HCG was 4 weeks, equivalent to 2 cycles. Notably, only 4 patients necessitated third-line chemotherapy following single-agent chemotherapy in the first and second lines.References
Joneborg U, Coopmans L, van Trommel N, Seckl M, A R Lok C. Fertility and pregnancy outcome in gestational trophoblastic disease. Int J Gynecol Cancer 2021;31(3):399–41.
Mazur M, Kurman R. Tumors of the female sex organs. Part 1. Hydatidiform mole and choriocarcinoma. Atlas Tumor Pathol 1956;9:16–8.
Ngan S, Seckl M J. Gestational trophoblastic neoplasia management: an update. Curr Opin Oncol 2007;19(5):486–91.
Balachandran K, Salawu A, Ghorani E, Kaur B, Sebire N, Short D, et al. When to stop human chorionic gonadotrophin (hCG) surveillance after treatment with chemotherapy for gestational trophoblastic neoplasia (GTN): a national analysis on over 4,000 patients. Gynecol Oncol 2019;155:8–12.
Bakri YN, Berkowitz RS, Khan J, Goldstein D, Sinner W, Jabbar FA. Pulmonary metastases of gestational trophoblastic tumor. Risk factors for early respiratory failure. J Reprod Med 1994;39(3):175–8.
Cagayan MS. Vaginal metastases complicating gestational trophoblastic neoplasia. J Reprod Med 2010;55(5-6):229–35.
Hongzhao S, Baozhen W. Brain metastasis in choriocarcinoma and malignant mole: an analysis of 98 cases. Chin Med J (Engl) 1979;92(3):164–74.
Bakri YN, Subhi J, Amer M, Ezzat A, Sinner W, Tweijry A, et al. Liver metastases of gestational trophoblastic tumor. Gynecol Oncol 1993;48(1):110–3.
National Comprehensive Cancer Network. [Internet]. [cited 2023 Aug 6]. Availabale from: https://www.nccn.org/professionals/physician_gls/pdf/gtn.pdf
Horowitz NS, Eskander RN, Adelman MR, Burke W. Epidemiology, diagnosis, and treatment of gestational trophoblastic disease: A Society of Gynecologic Oncology evidenced-based review and recommendation. Gynecol Oncol 2021;163(3):605–13.
Ross GT, Goldstein DP, Hertz R, Lipsett M, Odell W. Sequential use of methotrexate and actinomycin D in the treatment of metastatic choriocarcinoma and related trophoblastic diseases in women. Am J Obstet Gynecol 1965;93:223–9.
Maestá I, de Freitas Segalla Moreira M, Rezende-Filho J, Bianconi M, Jenkilevich G, Otero S, et al. Outcomes in the management of high-risk gestational trophoblastic neoplasia in trophoblastic disease centers in South America. Int J Gynecol Cancer 2020;30(9):1366–71.
Hussain A, Aziz SA, Bhatt GM, Lone AR, Hussain HI, Wani B, et al. Gestational Trophoblastic Neoplasia: Experience from a Tertiary Care Center of India. J Obstet Gynaecol India 2016;66(6):404–8.
Hussain SS, Raees M, Rahim R. Ten-Year Review of Gestational Trophoblastic Disease at Lady Reading Hospital, Peshawar. Cureus 2022;14(7):e26620.
Dauda AM, Akpor IO, Mandong BM, Ngeba J, Kwaghe B, Emmanuel I. Prevalence of gestational trophoblastic disease: an institution experience. Ann Trop Pathol 2017;8(2):81.
Talati NJ. The pattern of benign gestational trophoblastic disease in Karachi. J Pak Med Assoc 1998;48(10):296–300.
Al Riyami N, Al Riyami M, Al Hajri AT, Al Saidi S, Salman B, Al Kalbani M. Gestational trophoblastic disease at Sultan Qaboos University Hospital: Prevalence, risk factors, histological features, sonographic findings, and outcomes. Oman Med J 2019;34(3):200–4.
Kumar N, Saxena YK, Rathi AK, Chitra R, Kumar P. Host and risk factors for gestational trophoblastic disease: a hospital-based analysis from India. Med Sci Monit 2003;9(1):CR442–7.
Makhathini BS, Dreyer G, Buchmann EJ. Gestational trophoblastic disease managed at Grey’s Tertiary Hospital: a five-year descriptive study. South Afr Gynaecol Oncol 2019;11(2):17–21.
Capobianco G, Tinacci E, Saderi L, Dessole F, Petrillo M, Madonia M, et al. High incidence of gestational trophoblastic disease in a third-level university-hospital, Italy: a retrospective cohort study. Front Oncol 2021;11:684700.
McNeish IA, Strickland S, Holden L, Rustin GJ, Foskett M, Seckl MJ, et al. Low-risk persistent gestational trophoblastic disease: outcome after initial treatment with low-dose methotrexate and folinic acid from 1992 to 2000. J Clin Oncol 2002;20(7):1838–44. Ref no 21 and 29 are same
Matsui H, Iitsuka Y, Seki K, Sekiya S. Comparison of Chemotherapies with Methotrexate, VP-16 and Actinomycin-D in Low-Risk Gestational Trophoblastic Disease: Remission Rates and Drug Toxicities. Gynecol Obstet Invest 1998;46(1):5–8.
Lee YJ, Park JY, Kim DY, Suh DS, Kim JH, Kim YM, et al. Comparing and evaluating the efficacy of methotrexate and actinomycin D as first-line single chemotherapy agents in low-risk gestational trophoblastic disease. J Gynecol Oncol 2017;28(2):e8.
Ertkhachonsuk AA, Israngura N, Wilailak S, Tangtrakul S. Actinomycin d versus methotrexate-folinic acid as the treatment of stage I, low-risk gestational trophoblastic neoplasia: a randomized controlled trial. Int J Gynecol Cancer 2009;19(5):985–8.
Gilani MM, Yarandi F, Eftekhar Z, Hanjani P. Comparison of pulse methotrexate and pulse dactinomycin in the treatment of low-risk gestational trophoblastic neoplasia. Aust N Z J Obstet Gynaecol 2005;45(2):161–4.
Yarandi F, Eftekhar Z, Shojaei H, Kanani S, Sharifi A, Hanjani P. Pulse methotrexate versus pulse actinomycin D in the treatment of low-risk gestational trophoblastic neoplasia. Int J Gynaecol Obstet 2008;103(1):33–7.
Osborne RJ, Filiaci V, Schink JC, Mannel RS, Alvarez Secord A, kelley JL, et al. Phase III trial of weekly methotrexate or pulsed dactinomycin for low-risk gestational trophoblastic neoplasia: a gynecologic oncology group study. J Clin Oncol 2011;29(7):825–31.
Schink JC, Filiaci V, Huang HQ, Tidy J, Winter M, Carter J, et al. An international randomized phase III trial of pulse actinomycin-D versus multi-day methotrexate for the treatment of low risk gestational trophoblastic neoplasia; NRG/GOG 275. Gynecol Oncol 2020;158(2):354–60.
McNeish IA, Strickland S, Holden L, Rustin GJ, Foskett M, Seckl MJ, et al. Low-risk persistent gestational trophoblastic disease: outcome after initial treatment with low-dose methotrexate and folinic acid from 1992 to 2000. J Clin Oncol 2002;20(7):1838–44. Ref no 21 and 29 are same
Deng L, Zhang J, Wu T, Lawrie TA. Combination chemotherapy for primary treatment of high risk gestational trophoblastic tumour. Cochrane Database Syst Rev 2013;13(1)CD005196.
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