The management of high-risk gestational trophoblastic tumours (GTT).

Abstract

Between 1979 and 1995 we have treated 272 consecutive women with high-risk (GTT including 121 previously treated patients who were treated with the weekly EMA/CO (etoposide, methotrexate, actinomycin D alternating with cyclophosphamide and vincristine). The median follow-up is 4.5 years (range 1-16 years). The cumulative 5 year survival is 86.2% (95% confidence interval 81.9-90.5%). No deaths from GTT occurred later than 2 years after starting EMA/CO. In a multivariate analysis, adverse prognostic factors were the presence of liver metastases (p < 0.0001), interval from antecedent pregnancy > 24 months (p < 0.0001), brain metastases (p=0.0008) and term delivery of antecedent pregnancy (p=0.045). There were 11 (4%) early deaths while 213 (78%) achieved complete remission. 47 (17%) developed drug resistance to EMA/CO of whom 33 (70%) were salvaged by further cisplatinum based chemotherapy and surgery. 2 women developed acute myeloid leukaemia after treatment with EMA/CO. 56% of women who have been in remission for at least 2 years and had fertility conserving surgery have achieved pregnancy since completing EMA/CO and there have been 112 live births including 3 babies with congenital abnormalities. EMA/CO is an effective, easy to administer and well tolerated regimen for treating patient with high-risk GTT. More than half of these women will retain their fertility. However, there is a small but significant increase in second malignancies.

• Authors: E S Newlands, M Bower, L Holden, D Short, C Brock, G J Rustin, R H Begent, K D Bagshawe
• Journal: International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics (Int J Gynaecol Obstet) Vol. 60 Suppl 1 Pg. S65-70 (Apr 1998) ISSN: 0020-7292 [Print] United States
• PMID: 9833617 (Publication Type: Journal Article)

Chemical References

• Dactinomycin
• Vincristine
• Etoposide
• Cyclophosphamide
• Methotrexate

Topics

• Adolescent
• Adult
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Cyclophosphamide (administration & dosage)
• Dactinomycin (administration & dosage)
• Etoposide (administration & dosage)
• Female
• Humans
• Methotrexate (administration & dosage)
• Middle Aged
• Pregnancy
• Prognosis
• Retrospective Studies
• Survival Analysis
• Treatment Outcome
• Trophoblastic Neoplasms (drug therapy, mortality)
• Uterine Neoplasms (drug therapy, mortality)
• Vincristine (administration & dosage)