Abstract | OBJECTIVE: METHODS: Medical records of 42 patents with drug-resistant GTN who were treated by chemotherapy combined with surgical management at Peking Union Medical College Hospital from Jan 1996 to Jan 2006 were reviewed. RESULTS: Among 42 patients, 32 achieved serologically complete remission (SCR) with an SCR rate of 76%, and 10 patients had a treatment failure. Treatment failure was more frequently seen in patients who also had metastasis of other sites except for lungs and vagina and patients with antecedent non- molar pregnancy (P = 0.023 and 0.017, respectively). Preoperative human chorionic gonadotropin-beta subunit (beta-hCG) titer > 10 U/L (P = 0.020), failure to reach normal serum titers of beta-hCG during treatment (P = 0.003), age > or = 35 years (OR: 12.6, 95% CI: 2.4 - 66.0, P = 0.002) and preoperative chemotherapy regimens > or = 4 (OR: 4.5, 95% CI: 1.0 - 20.1, P = 0.059) were also correlated with treatment failure. All the 10 patients with treatment failure had at least 3 of 6 above mentioned predictors of treatment failure. CONCLUSIONS: Surgical management combined with chemotherapy is effective in the treatment of drug-resistant GTN. Age > or = 35 years, antecedent non- molar pregnancy, metastasis of other sites except for lungs and vagina, preoperative beta-hCG titer > 10 U/L, failure to reach normal serum titers of beta-hCG during treatment, and preoperative chemotherapy regimens > or = 4 are significant predictors of treatment failure. Patients with 3 or more predictors of treatment failure usually have poor prognosis. Therefore, surgical management should not be performed for these patients.
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Authors | Feng-Zhi Feng, Yang Xiang, Yang Cao, Lei Li, Xi-Run Wan, Xiu-Yu Yang |
Journal | Zhonghua fu chan ke za zhi
(Zhonghua Fu Chan Ke Za Zhi)
Vol. 43
Issue 10
Pg. 728-31
(Oct 2008)
ISSN: 0529-567X [Print] China |
PMID | 19087536
(Publication Type: Evaluation Study, Journal Article)
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Chemical References |
- Chorionic Gonadotropin, beta Subunit, Human
- Dactinomycin
- Etoposide
- Fluorouracil
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Topics |
- Adult
- Antineoplastic Combined Chemotherapy Protocols
(therapeutic use)
- Chorionic Gonadotropin, beta Subunit, Human
(blood)
- Combined Modality Therapy
- Dactinomycin
(administration & dosage)
- Drug Resistance, Neoplasm
- Etoposide
(administration & dosage)
- Female
- Fluorouracil
(administration & dosage)
- Gestational Trophoblastic Disease
(drug therapy, pathology, surgery)
- Humans
- Hysterectomy
- Lung Neoplasms
(secondary, surgery)
- Middle Aged
- Neoplasm Staging
- Pregnancy
- Retrospective Studies
- Treatment Outcome
- Uterine Neoplasms
(drug therapy, pathology, surgery)
- Young Adult
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