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CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2020; 41(03): 345-350
DOI: 10.4103/ijmpo.ijmpo_235_18
Original Article

Management of “Ultra-High Risk” Gestational Trophoblastic Neoplasia at a Tertiary Center in India

Shilpa M Patel
Department of Gynecologic Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
,
Ruchi Arora
Department of Gynecologic Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
,
Rajnish Tiwari
Department of Gynecologic Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
,
Pabashi Poddar
Department of Gynecologic Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
,
Ava Desai
Department of Gynecologic Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
,
Meeta H Mankad
Department of Gynecologic Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
,
Harsha P Panchal
Department of Medical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
› Author Affiliations Financial support and sponsorship Nil.
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Abstract

Aims: The aim of this study is to identify clinicopathological features associated with increased morbidity and mortality in cases of “ultra-high risk” gestational trophoblastic neoplasia (GTN) and to compare initial low-dose etoposide-cisplatin (EP) induction chemotherapy with respect to etoposide methotrexate adriamycin cyclophosphamide vincristine (EMACO) regimen. Settings and Design: This was a retrospective study of patients of high-risk GTN from January 2012 to December 2016 with criteria mentioned as “ultra-high-risk group;” pathological or suspected diagnosis of choriocarcinoma, multiple (>20) pulmonary metastases or associated with hemoptysis, brain metastases, large-volume liver metastases, profuse vaginal bleeding, human chorionic gonadotropin >1000,000 IU/L, interval since the last antecedent pregnancy of >2.8 years. Subjects and Methods: Comparison between the two groups of chemotherapy regimens and the median number of chemotherapy courses required to achieve complete remission was done Statistical Analysis Used: Data were analyzed using the SPSS software version 18 and Fisher's exact test with P value statistically significant at the level of 0.05. Results: Thirty-seven cases were high-risk GTN and 24 were “ultra-high risk.” The higher percentage of patients underwent remission of disease following low-dose induction chemotherapy as compared to primary EMACO therapy, 71.4% versus 58.8%. No resistance to second-line chemotherapy was noted, and no surgical intervention was required in the patients receiving low-dose induction chemotherapy before EMACO. Conclusions: We noted a decrease in the proportion of patients developing resistance to primary chemotherapy and lesser adverse effects in those receiving initial low-dose induction EP chemotherapy.

Keywords

Choriocarcinoma - EMACO regimen - gestational trophoblastic neoplasia - high risk gestational trophoblastic neoplasia - low-dose etoposide-cisplatin


Publication History

Received: 29 October 2018

Accepted: 10 November 2019

Article published online:
28 June 2021

© 2020. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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