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High-risk metastatic gestational trophoblastic tumors. Current management.

Abstract
Aggressive multimodality therapy with an appropriate combination of chemotherapy and adjuvant radiotherapy and surgery has resulted in a cure for most patients with high-risk, metastatic gestational trophoblastic tumors. The EMA-CO chemotherapy regimen, employing etoposide, high-dose methotrexate, actinomycin D, cyclophosphamide and vincristine, is highly effective and well tolerated. Complete response rates of 80-94% and survival rates of 82-100% have been reported. For patients with central nervous system metastases, whole brain irradiation is given simultaneously with the initiation of combination chemotherapy employing a high-dose methotrexate infusion. Surgical procedures, especially hysterectomy and thoracotomy, may be useful for the purpose of removing known foci of chemotherapy-resistant disease. Subsequent salvage chemotherapy with cisplatin and bleomycin in combination with etoposide will result in a cure for almost all patients. The factors that are most important in determining response to treatment in patients with metastatic, high-risk disease are metastases to sites other than the lung and vagina, more than eight metastases, previous failed chemotherapy and a World Health Organization score > or = 8.
AuthorsJ R Lurain
JournalThe Journal of reproductive medicine (J Reprod Med) Vol. 39 Issue 3 Pg. 217-22 (Mar 1994) ISSN: 0024-7758 [Print] United States
PMID7518518 (Publication Type: Journal Article, Review)
Chemical References
  • Bleomycin
  • Dactinomycin
  • Vincristine
  • Etoposide
  • Cyclophosphamide
  • Methotrexate
Topics
  • Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
  • Bleomycin (administration & dosage)
  • Brain Neoplasms (epidemiology, pathology, secondary, therapy)
  • Clinical Protocols
  • Clinical Trials as Topic
  • Combined Modality Therapy
  • Cranial Irradiation
  • Cyclophosphamide (administration & dosage)
  • Dactinomycin (administration & dosage)
  • Etoposide (administration & dosage)
  • Female
  • Humans
  • Hysterectomy
  • Lung Neoplasms (epidemiology, pathology, secondary, therapy)
  • Methotrexate (administration & dosage)
  • Neoplasm Staging
  • Pregnancy
  • Prognosis
  • Remission Induction
  • Risk Factors
  • Survival Rate
  • Thoracotomy
  • Treatment Outcome
  • Trophoblastic Neoplasms (epidemiology, pathology, secondary, therapy)
  • Uterine Neoplasms (pathology)
  • Vaginal Neoplasms (epidemiology, pathology, secondary, therapy)
  • Vincristine (administration & dosage)

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