Factors related to treatment outcomes in low-risk gestational neoplasia
Tumori 2017; 103(2): 177 - 181
Article Type: ORIGINAL RESEARCH ARTICLE
AuthorsOsman Turkmen, Derman Basaran, Alper Karalok, Gunsu Comert Kimyon, Tolga Tasci, Isin Ureyen, Gokhan Tulunay, Taner Turan
To define the factors associated with methotrexate (MTX) resistance in patients with low-risk gestational trophoblastic neoplasia (GTN).
A total of 63 patients with low-risk GTN according to International Federation of Gynecology and Obstetrics (FIGO) criteria were included. A total of 37 (58.7%) patients were treated with successive doses of 1 mg/kg intramuscular (IM) MTX on days 1, 3, 5, and 7, and 0.1 mg/kg IM folinic acid (FA) on days 2, 4, 6, and 8, until β-human chorionic gonadotropin (hCG) levels were normalized. After the β-hCG value dropped to the normal level, an additional cycle of MTX/FA was administered. This protocol is defined as the standard protocol. In a watchful waiting protocol, the same 8-day IM MTX/FA regimen was given only once (n = 8) or twice (n = 18) to 26 (41.3%) patients and patients in whom β-hCG values declined were subjected to follow-up and no additional cycles were administered as long as there was a decrease in β-hCG value. Clinical response and factors affecting therapeutic outcomes were analyzed retrospectively.
Of 63 patients, 47 (74.3%) were cured with primary MTX/FA treatment irrespective of any protocol. Of the 16 patients who were not able to be treated with primary MTX/FA, 3 were treated with single-agent actinomycin-D and 11 were treated with multi-agent chemotherapy. Univariate analysis showed that a pretreatment β-hCG level of ≥5000 IU/L was related to reduced therapeutic response (p = 0.001). The FIGO score, antecedent gestational pathology, and treatment with standard or watchful waiting protocol were not related to treatment response.
The level of β-hCG prior to therapy is an important factor for predicting therapeutic outcomes. It should be noted that the success of the therapy decreases notably in case of high β-hCG level.
- • Accepted on 13/07/2016
- • Available online on 04/08/2016
- • Published in print on 24/03/2017
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- Turkmen, Osman [PubMed] [Google Scholar] , * Corresponding Author (email@example.com)
- Basaran, Derman [PubMed] [Google Scholar]
- Karalok, Alper [PubMed] [Google Scholar]
- Kimyon, Gunsu Comert [PubMed] [Google Scholar]
- Tasci, Tolga [PubMed] [Google Scholar]
- Ureyen, Isin [PubMed] [Google Scholar]
- Tulunay, Gokhan [PubMed] [Google Scholar]
- Turan, Taner [PubMed] [Google Scholar]
Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women’s Health Teaching and Research Hospital, Ankara - Turkey