30 years' experience in the treatment of low-risk gestational trophoblastic neoplasia in Hungary

Vilmos Fülöp, Ivan Szigetvári, János Szepesi, György Végh, József Bátorfi, Zoltan Nagymányoki, Miklos Török, Ross S. Berkowitz

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Abstract

OBJECTIVE: To review the clinical experience in the treatment of patients with low-risk gestational trophoblastic neoplasia (GTN) over the past 30 years in a national trophoblastic disease center. STUDY DESIGN: Between January 1, 1977, and December 31, 2007, 302 patients with low-risk GTN were treated. The patients were directed to our institution from all parts of Hungary. The patients were 14 to 53 years of age with an average age of 28.3 years. Methotrexate (MTX)/folinic acid or actinomycin- D (Act-D) primary chemotherapy was selected based upon the patient's stage and prognostic score of GTN. RESULTS: Among 218 low-risk patients, 210 (96.3%) achieved remission as a result of MTX therapy. In 8 patients (3.7%), MTX-Act-D-cyclophosphamide (MAC) combination chemotherapy was needed to achieve complete remission, in some cases assisted by operation. Among 84 patients, 81 (96.4%) achieved remission as a result of Act-D therapy. In 3 cases (3.6%) complete remission was achieved by MAC combination chemotherapy. We detected metastases in 22.8% (69/302) of our low-risk patients. Chemotherapy, surgical intervention or other supplementary treatments resulted in 100% remission in cases of low-risk nonmetastatic and metastatic disease. CONCLUSION: Our data indicate that MTX/folinic acid or Act-D should be the primary treatment in patients with nonmetastatic or metastatic low-risk GTN. Importantly, patients with resistance to single-agent chemotherapy regularly achieve omplete remission with MAC combination chemotherapy. Results show that patient care under the direction of experienced clinicians serves to optimize the opportunity for cure and minimize morbidity.

Original languageEnglish
Pages (from-to)253-257
Number of pages5
JournalJournal of Reproductive Medicine for the Obstetrician and Gynecologist
Volume55
Issue number5-6
Publication statusPublished - May 1 2010

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Keywords

  • Anatomical stages
  • Chemotherapy
  • Low risk gestational trophoblastic neoplasia
  • Prognostic score

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynaecology

Cite this

Fülöp, V., Szigetvári, I., Szepesi, J., Végh, G., Bátorfi, J., Nagymányoki, Z., Török, M., & Berkowitz, R. S. (2010). 30 years' experience in the treatment of low-risk gestational trophoblastic neoplasia in Hungary. Journal of Reproductive Medicine for the Obstetrician and Gynecologist, 55(5-6), 253-257.