Treatment and Prognosis of High-Risk Gestational Trophoblastic Diseases

Abstract

Based on 36 patients of high-risk gestational trophoblastic neoplasia treated with single and multiple agents chemotherapy in the Department of Obstetrics and Gynecology, Seoul National University Hospital from 1980 to 1984, the analysis of the clinical courses and therapeutic methods were carried out in order to obtain the more effective methods of treatment and improvement of the survival rate. Chemotherapeutic agents we had used were Methotrexate, Actinomycin-D, MAC III (Methotrexate, Actinomycin-D and Cytoxan), MBP (Modified Bagshawe Protocol), and VBP (Vincristine, Bleomycin and Cis-platin) regimens. About 60% (21 of 36) achieved complete remission after chemotherapy and adjunctive surgery: 53% (16 of 30) for metastatic disease and 83% (5 of 6) for non-metastatic disease. We could obtain two representative patterns of f3 -hCG regression curve in each complete and non-complete remission group from which the prognosis of the high-risk patients with gestational trophoblastic disease was anticipated. We considered five high-risk factors significantly influencing response to treatment as follows: 1) pretreatment titer of greater than 100,000 mIU/ml serum f3 -hCG, 2) brain or liver metastasis, 3) trophoblastic disease after full-term pregnancy, 4) duration of disease greater than 4 months, and 5) prior unsuccessful chemotherapy. The most important factors much influencing the survival rate were 1) and 4). Significant myelosuppression was encountered especially in the patients treated with multiple agent chemotherapy than those with single agent chemotherapy. But, the present study noted that the remission rate of high-risk patients with gestational trophoblastic disease who were treated with single agent chemotherapy was only 32%, on the other hand, remission rate of patients treated with secondary multiple agent chemotherapy was significantly increased. We thus concluded it was very important that more aggressive primary treatment using multiple agent chemotherapy or new more effective regimen including MBP should be done to shorten the duration of treatment as early as possible depending on the regression curve and the clinical status for the high-risk patients with gestational trophoblastic disease.