Title: A Retrospective Observational Study of Patients with High-Risk Gestational Trophoblastic Neoplasm treated at Chittagong Medical College Hospital
Authors: Dr Jannatun Nisa, Prof. Dr MD. Mokhles Uddin, Dr Syeda Umma Tasmia, Dr Fahmida Alam, Dr Sajjad Mohammad Yusuff
DOI: https://dx.doi.org/10.18535/jmscr/v10i4.06
Abstract
Objective: Gestational trophoblastic tumors are a spectrum of interrelated conditions arising from an abnormal fertilization, most of them are highly sensitive to chemotherapy & curable in metastatic disease also. The aim of the study was to observe the outcome of high-risk Gestational trophoblastic neoplasia in Bangladeshi perspective.
Methods: This is a retrospective observational study of 31 women of high-risk gestational trophoblastic neoplasia conducted at Radiotherapy Department of Chittagong Medical College Hospital over a period of 4.5 years from January 2013 to June 2018. Only the patients with high-risk characteristics were included in this study. All patients were treated with EMA-CO chemotherapy regimen as first line chemotherapy. Second line chemotherapy with EP/EMA was given to patients having poorer response to primary chemotherapy or showing progression of disease.
Results: Of the 31 patients 3 were lost to follow up during treatment & 28 patients were evaluated. Among 28 patients 22 (79%) patients achieved complete remission with EMA-CO regimen & 6(21%) patients become refractory to EMA-CO & received subsequent chemotherapy with EP/ EMA, VIP regimen.5 more patients achieved complete remission with 2nd and 3rd line chemotherapy. Thus, overall complete response rate was 96.43% (27/28).
Conclusion: In the present study a complete remission of 96.43% patients achieved which is comparable with other relevant studies. So, the preferred primary chemotherapy regimen in high-risk GTN is EMA-CO.
Keywords: Gestational trophoblastic tumors, EMA-CO chemotherapy.
References
- Ravi Byahut, Mithilesh Kumar. Evaluation of the results of chemotherapy in high-risk gestational trophoblastic tumors with multidrug EMA-CO regimen +granulocyte-colony stimulating factor (G-CSF) support. International Journal of Contemporary Medical Research 2018; 5(1): 1-4.
- Berkowitz RS. Goldstein DP. Current management of gestational trophoblastic disease. Gynecol oncol.2009; 112: 654-662.
- Chauhan Anjana, Desai Ava, patelshilpa, Kapadia Anila, Garg sonali, Dave Kalpana. High Risk Gestational Trophoblastic Tumors. J Obstet Gynecol India 2007; 57(3):221-226.
- Kohorn EI. The new FIGO 2000 staging & risk factor scoring system for gestational trophoblastic disease: description & critical assessment. Int J Gynecol Cancer. 2001; 11: 73-77.
- Veeraraghavan G, Kanchana MP, Srinivasan LN. A 3 year retrospective study on gestational trophoblastic disease in a Government obstetrical tertiary care center. Int J Reprod centracept obstet gynecol 2016; 5: 4405-9.
- Ngan HY, Seckl MJ, Berkwitz RS, Xiang Y, Golfier F, Sekharan PK, Lurain JR. Update on the diagnosis & management of gestational trophoblastic disease. Int J Gynecol obstet. 2015; 131: 5123-6.
- Lurain JR. Gestational trophoblastic disease II: classification & management of gestational trophoblastic neoplasia. Ann J Obstet Gynecol. 2011; 204(1): 11-8.
- Lan Z, Hong Z hao, Xiuyv Y, Yang X. Primary outcomes of patients who conceived within 1 year after chemotherapy for gestational trophoblastic tumor: A clinical report of 22 patients. Gynecoloncol. 2001; 83(1): 146-8.
- Newlands ES, Bagshwae KD, Begent RH et al. Developments in chemotherapy for medium and high risk patients with gestational trophoblastic tumors (1979-1984). Br J ObstetGynecol 1986; 93:63-9.
- Bower M, Newlands ES, Holden et al. EMA-CO for high risk gestational trophoblastic tumors: results from a cohort of 272 patients. J Clin Oncol 1997;15:2636-43.
- Bafna UD, Ahuja VK, Umadevi K et al. Gestational trophoblastic tumors-situation analysis in a third world regional cancer center. Int J Gynecol Cancer. 1997;7:197-204.