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.
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Authors | J R Lurain |
Journal | The Journal of reproductive medicine
(J Reprod Med)
Vol. 39
Issue 3
Pg. 217-22
(Mar 1994)
ISSN: 0024-7758 [Print] United States |
PMID | 7518518
(Publication Type: Journal Article, Review)
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Chemical References |
- Bleomycin
- Dactinomycin
- Vincristine
- Etoposide
- Cyclophosphamide
- Methotrexate
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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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