Subscribe to RSS
DOI: 10.1055/s-0042-1758356
Gestational Trophoblastic Neoplasia—A Retrospective Analysis of Patients Treated at a Tertiary Care Oncology Center in North India
Abstract
Objectives The aim of this study was to do a retrospective analysis of patients of gestational trophoblastic neoplasia (GTN) treated at our center concerning their clinical features and treatment outcomes.
Materials and Methods Patients diagnosed and treated from May 2018 to December 2021 were included. All relevant information pertaining to eligible patients was retrieved from the electronic medical records. Patients were risk-stratified based on the World Health Organization (WHO) risk scoring system with a score of seven and above being classified into the high-risk category. Patients were monitored for response by measuring β-human chorionic gonadotrophin (β-HCG) levels before each consecutive cycle.
Statistical Analysis Appropriate statistical analysis was performed using SPSS version 26.
Results Records of 39 eligible patients were analyzed for clinical features out of which 38 were eligible for response assessment. The median age of presentation was 28 years with the majority of patients (79.4%) diagnosed based on β-HCG levels and clinical history alone. The most common symptom was bleeding per vagina (64%), while the majority of antecedent pregnancies were abortions (59%).
Of the 14 low-risk category patients, 12 received single-agent methotrexate/actinomycin D, while 2 received etoposide, methotrexate actinomycin D (EMACO) regimen. Overall response rates were 85.7% with the others responding to the second-line EMACO regimen. Five patients in this group had a WHO score of 5 or 6 and all of them responded to single-agent treatment. Among the 25 high-risk category patients, all received the EMACO regimen with high-dose methotrexate added to those with brain metastasis. The response rate was 87.5% with all the nonresponders having features of ultra-high risk of liver/brain metastasis and/or a WHO score of more than 12. While one nonresponder had expired despite treatment, the other two responded to the etoposide methotrexate and actinomycin D/ etoposide and cisplatin regimen.
Conclusion Our results are in consonance with other reported studies. The subcategories of low-risk GTN with a WHO score of 5 and 6 and high-risk GTN with ultra-high-risk features deserve further research in the form of multicenter prospective studies.
Publication History
Article published online:
02 March 2023
© 2023. MedIntel Services Pvt Ltd. 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/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
- 1 Lurain JR. Gestational trophoblastic disease I: epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease, and management of hydatidiform mole. Am J Obstet Gynecol 2010; 203 (06) 531-539
- 2 Horowitz NS, Eskander RN, Adelman MR, Burke W. Epidemiology, diagnosis, and treatment of gestational trophoblastic disease: A Society of Gynecologic Oncology evidenced-based review and recommendation. Gynecol Oncol 2021; 163 (03) 605-613
- 3 Di Cintio E, Parazzini F, Rosa C, Chatenoud L, Benzi G. The epidemiology of gestational trophoblastic disease. Gen Diagn Pathol 1997; 143 (2-3): 103-108
- 4 Ngan HYS, Seckl MJ, Berkowitz RS. et al. Update on the diagnosis and management of gestational trophoblastic disease. Int J Gynaecol Obstet 2018; 143 (Suppl. 02) 79-85
- 5 Gulia S, Bajpai J, Gupta S. et al. Outcome of gestational trophoblastic neoplasia: experience from a tertiary cancer centre in India. Clin Oncol (R Coll Radiol) 2014; 26 (01) 39-44
- 6 Ghosh J, Dey S, Mandal D. et al. Clinicopathological features and outcomes of choriocarcinoma: a retrospective analysis from an Indian tertiary cancer center. Cancer Res Stat Treat 2021; 4: 486-491
- 7 Singh S, Shekhar C, Acharya R. et al. The incidence of abortion and unintended pregnancy in India, 2015. Lancet Glob Health 2018; 6 (01) e111-e120
- 8 Gupta A, Kapoor A. Gestational trophoblastic neoplasia: a road less travelled. Cancer Res Stat Treat 2021; 4: 786-787
- 9 Winter MC. Treatment of low-risk gestational trophoblastic neoplasia. Best Pract Res Clin Obstet Gynaecol 2021; 74: 67-80
- 10 Braga A, Paiva G, Ghorani E. et al. Predictors for single-agent resistance in FIGO score 5 or 6 gestational trophoblastic neoplasia: a multicentre, retrospective, cohort study. Lancet Oncol 2021; 22 (08) 1188-1198
- 11 Alifrangis C, Agarwal R, Short D. et al. EMA/CO for high-risk gestational trophoblastic neoplasia: good outcomes with induction low-dose etoposide-cisplatin and genetic analysis. J Clin Oncol 2013; 31 (02) 280-286