The diagnostics and treatment of low-risk gestational trophoblastic neoplasia (GTN): 42-year experience

Objective: To review the results in the surgical and chemotherapy treatment of low-risk gestational trophoblastic neoplasia (GTN) in the last 42 years in Hungary. Mehtods: This is a retrospective cohort study. Between 1 January 1977 and 31 December 2018, 413 patients were treated with low-risk GTN at our hospital. The patients were between 14-49 years of age with a mean age of 28.1 years. Primary chemotherapy was selected based upon the patient's GTN stage and prognostic score. Hysterectomies were done either electively (requested by patients who completed childbearing) or to remove large uterine tumour burdens. Results: Methotrexate (MTX)/folinic acid was used as a primary therapy in 304 cases, and among these 289 patients achieved complete remission (95.1%). Nine chemotherapy-resistant patients were successfully treated with secondary MAC [MTX, Actinomycin-D (Act-D), cyclophosphamide] and 6 patients with EMA-CO (etoposide, MTX, Act-D, cyclophosphamide, vincristine) therapy. Out of 109 patients, 102 (93.6%) achieved remission following treatment with Act-D. The remining 7 patietns achieved remission with MAC (1 case) or EMA-CO (6 cases) as secondary therapy. Metastases were detected in 98 (23.7%) out of the 413 low-risk patients. Hysterectomy was performed in 28 (6.8%) patients, and among these, 10 patients were diagnosed with Stage I, 4 with Stage II, and 14 with Stage III disease. Surgical resection of metastases was necessary in 12 (2.9%) cases. Conclusions: During the study period, approximately 75% of our patients with low risk GTN were primarily treated with MTX/folinic acid and 25% with Act-D. Single agent chemotherapy-resistant patients were succesfully treated with MAC and, more recently, with EMA-CO. Hysterectomy and metastasis resection occassionally play a valuable role in the management of this disease.