[Efficacy of surgical management combined with chemotherapy in the treatment of drug-resistant gestational trophoblastic neoplasm].

Abstract

OBJECTIVE:

To evaluate the efficacy of surgical management combined with chemotherapy in the treatment of drug-resistant gestational trophoblastic neoplasm (GTN) patients, and investigate factors influencing the outcome of the surgery combined with chemotherapy.

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.

• 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)

Chemical References

• Chorionic Gonadotropin, beta Subunit, Human
• Dactinomycin
• Etoposide
• Fluorouracil

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