Management of high-risk hydatidiform mole and persistent gestational trophoblastic neoplasia: the Korean experience.

Abstract

OBJECTIVE:

To test the efficacy of a new scoring system to differentiate high-risk hydatidiform mole (H-mole) and initiate early selective postmolar chemotherapy.

STUDY DESIGN:

According to Kim's scoring system, 262 patients were identified as high-risk H-mole patients. Fifty (19.1%) received early chemotherapy, and the rest constituted the control group. Salvage therapy with etoposide, methotrexate, actinomycin D/etoposide, cisplatin (EMA/EP) and taxol, cisplatin/taxol, etoposide (TP/TE) was applied in 21 cases of ultra-high-risk GTT.

RESULTS:

None of the 50 cases in the early chemotherapy group progressed to persistent GTT. However, 58.9% in the control group developed GTT with 8.0% drug resistance. Of those receiving salvage therapy in the 21 ultra-high-risk GTT cases resistant to EMA/CO, 10 of 14 (71%) receiving EMA/EP and 4 of 7 (57.1%) receiving TP/TE achieved remission.

CONCLUSION:

Early postmolar chemotherapy for high-risk H-mole is effective in preventing progression to persistent GTT and treatment failure. Ultra-high-risk GTT should be approached with multimodal treatment, including EMA/EP and TP/TE regimens.

• Authors: Seung Jo Kim, Young Jeong Na, Sang Geun Jung, Chan Joo Kim, Seog Nyeon Bae, Chan Lee
• Journal: The Journal of reproductive medicine (J Reprod Med) Vol. 52 Issue 9 Pg. 819-30 (Sep 2007) ISSN: 0024-7758 [Print] United States
• PMID: 17939600 (Publication Type: Journal Article)

Chemical References

• Dactinomycin
• Etoposide
• Paclitaxel
• Cisplatin
• Methotrexate

Topics

• Adult
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Case-Control Studies
• Cisplatin (administration & dosage)
• Dactinomycin (administration & dosage)
• Etoposide (administration & dosage)
• Female
• Humans
• Hydatidiform Mole (complications, drug therapy, surgery)
• Korea
• Methotrexate (administration & dosage)
• Middle Aged
• Neoplasm Recurrence, Local (diagnosis, prevention & control)
• Paclitaxel (administration & dosage)
• Pregnancy
• Prospective Studies
• Registries
• Retrospective Studies
• Risk Factors
• Salvage Therapy
• Severity of Illness Index
• Uterine Neoplasms (complications, drug therapy, surgery)