F Taylor1, T Grew, J Everard, L Ellis, M C Winter, J Tidy, B W Hancock, R E Coleman. 1. Sheffield Centre for Trophoblastic Disease, Weston Park Hospital, Cancer Research-UK/Yorkshire Cancer Research Sheffield Cancer Research Centre, Sheffield, UK. Electronic address: F.Taylor@sheffield.ac.uk.
Abstract
BACKGROUND: Gestational trophoblastic neoplasia (GTN) persisting despite local treatment requires chemotherapy. In 2000, the revised International Federation of Gynaecology and Obstetrics (FIGO)/World Health Organisation (WHO) staging system was introduced, classifying patients as at 'low' or 'high' risk for resistance to single agent treatment. PATIENTS AND METHODS: We have evaluated the complete response rates of patients with low risk GTN treated with 2 weekly intramuscular (IM) methotrexate 50mg four doses days 1, 3, 5, 7 and oral folinic acid 15 mg days 2, 4, 6, 8 (MTX/FA). Patient data between January 2000 and December 2011 were collated and the relationships between FIGO/WHO risk score and outcomes evaluated. RESULTS: Two hundred and eighty nine patients were treated with single agent IM MTX/FA and assessed for treatment response. 29/36 (81%) patients with a FIGO/WHO total score of 6 developed resistance to MTX/FA compared with 87/253 (34%) patients with a score of 0-5 (p ≤ 0.0001). Significantly higher rates of resistance were found for patients with an hCG level of >100,000 iu/l compared to an hCG level of <100,000 iu/l (84% versus 34% p ≤ 0.0001). All patients were eventually cured with chemotherapy or surgical salvage. CONCLUSIONS: Patients with low risk GTN that have a FIGO/WHO score of 6 or hCG level of >100,000 iu/l have high rates of resistance to MTX/FA and require further treatment. Revision of the FIGO/WHO scoring system may be appropriate to enable selection of more effective first line chemotherapy.
BACKGROUND:Gestational trophoblastic neoplasia (GTN) persisting despite local treatment requires chemotherapy. In 2000, the revised International Federation of Gynaecology and Obstetrics (FIGO)/World Health Organisation (WHO) staging system was introduced, classifying patients as at 'low' or 'high' risk for resistance to single agent treatment. PATIENTS AND METHODS: We have evaluated the complete response rates of patients with low risk GTN treated with 2 weekly intramuscular (IM) methotrexate 50mg four doses days 1, 3, 5, 7 and oral folinic acid 15 mg days 2, 4, 6, 8 (MTX/FA). Patient data between January 2000 and December 2011 were collated and the relationships between FIGO/WHO risk score and outcomes evaluated. RESULTS: Two hundred and eighty nine patients were treated with single agent IM MTX/FA and assessed for treatment response. 29/36 (81%) patients with a FIGO/WHO total score of 6 developed resistance to MTX/FA compared with 87/253 (34%) patients with a score of 0-5 (p ≤ 0.0001). Significantly higher rates of resistance were found for patients with an hCG level of >100,000 iu/l compared to an hCG level of <100,000 iu/l (84% versus 34% p ≤ 0.0001). All patients were eventually cured with chemotherapy or surgical salvage. CONCLUSIONS:Patients with low risk GTN that have a FIGO/WHO score of 6 or hCG level of >100,000 iu/l have high rates of resistance to MTX/FA and require further treatment. Revision of the FIGO/WHO scoring system may be appropriate to enable selection of more effective first line chemotherapy.