Treatment of metastatic gestational choriocarcinoma with oral methotrexate in a combat environment.

Abstract

BACKGROUND:

Gestational trophoblastic neoplasia (GTN) is a rare neoplastic complication of pregnancy. This disease can be successfully treated with parenteral intravenous or intramuscular chemotherapy. We present a case of metastatic gestational choriocarcinoma following a term pregnancy that was treated successfully with oral methotrexate therapy.

CASE:

A 25-year-old, G4 P4, native Afghani with a history of irregular menses since the birth of her son 6 months ago received a physical examination that was within normal limits. Pelvic examination revealed minimal blood in the vault and slight bleeding from a closed cervical os. The uterus was slightly enlarged, 5 weeks in size, and without any adnexal masses. Laboratory evaluation was significant for a positive urine and serum beta-HCG. Pelvic ultrasound examination revealed a 5-cm uterus with a 2-cm endometrial stripe. Chest radiograph revealed multiple bilateral ill-defined pulmonary nodules confirmed by computerized tomography. The patient underwent dilation and curettage productive of a moderate amount of tissue. The patient continued to have positive serum beta-HCGs and was given the presumptive diagnosis of FIGO stage III gestational choriocarcinoma. Because of the lack of intravenous chemotherapeutic agents, the patient was begun on methotrexate 0.40 mg/kg orally on days 1-5, with 9 days off. The patient completed one course of chemotherapy, followed by an interval total abdominal hysterectomy with bilateral salpingo-oophorectomy. The patient had a complete response to therapy and was treated with oral methotrexate for 2 courses after a negative serum beta-HCG. The patient tolerated the chemotherapy without any complication.

CONCLUSION:

Methotrexate is routinely used in a parenteral intramuscular fashion for the treatment of gestational choriocarcinoma. Physicians should be aware that, in very limited situations, oral methotrexate in combination with hysterectomy still could offer a patient successful treatment for stage III GTN.

• Authors: John H Farley, R Brian Heathcock, Walter Branch, Wilma Larsen, Dallas Homas
• Journal: Obstetrics and gynecology (Obstet Gynecol) Vol. 105 Issue 5 Pt 2 Pg. 1250-4 (May 2005) ISSN: 0029-7844 [Print] United States
• PMID: 15863599 (Publication Type: Case Reports, Journal Article)

Chemical References

• Methotrexate

Topics

• Administration, Oral
• Adult
• Biopsy, Needle
• Chemotherapy, Adjuvant
• Choriocarcinoma (pathology, secondary, therapy)
• Dose-Response Relationship, Drug
• Drug Administration Schedule
• Female
• Follow-Up Studies
• Gestational Trophoblastic Disease (diagnosis, therapy)
• Humans
• Hysterectomy (methods)
• Immunohistochemistry
• Methotrexate (therapeutic use)
• Neoplasm Metastasis
• Neoplasm Staging
• Postpartum Period
• Pregnancy
• Risk Assessment
• Treatment Outcome