Lara MF, Alvarado MA, Candelaria M, Arce SC

Language: Spanish
References: 22
Page: 308-314
PDF size: 65.94 Kb.

ABSTRACT

Introduction: Gestational trophoblastic disease represents a variety of conditions that include hydatiform mole and choriocarcinoma. The common manifestation is high levels of beta human chorionic gonadotropin. In Mexico the incidence of the disease is 2.5 per 1,000 pregnancies.
Patients and methods: This is a retrospective and descriptive analysis of patients with partial, complete or persistent hydatiform mole or choriocarcinoma diagnosis made from January 1988 to December 2003. We studied demographic characteristics, risk groups, treatment and response. We used descriptive statistics, multivariate analysis and Kaplan-Meier method for the survival analysis.
Results: We found 71 cases, the mean age at diagnosis was of 26 years, and 60.6% had choriocarcinoma. Vaginal bleeding was the most common manifestation at diagnosis. Thirty patients had low risk disease and 25 of them received chemotherapy based in methotrexate and folinic acid, 88% had complete response. In 10% of the cases the use of salvage chemotherapy showed a complete response. Overall survival was 100% at five years. Forty-one cases belonging to intermediate and high risk group were treated with chemotherapy (etoposide and actinomycin D in 68.3%). Overall response was of 90.2%, with complete response in 58.5% and partial response in 33.3%. Overall survival was of 94% at five years. Two cases developed second malignancies secondary to etoposide.
Conclusion: Our results are similar to those reported in the literature. Overall survival in the low risk group was 100% and in the intermediate and high risk group of 94%. Etoposide and actynomicine D as first line chemotherapy had comparable results to those reported with EMA-CO and MAC.

REFERENCES

1. Berkowits R, Goldstein DP. Chorionic tumors. N Engl J Med 1996;335:1740-8.

2. Seper DA, Macfee MS. Gestational trophoblastic disease. Epidemiology. Semin Oncol 1995;22:109-13.

3. Lira-Plascencia J, Tenorio-González F, Gomezpedroso-Rea J, et al. Gestational trophoblastic disease. A 6 year experience at the Instituto Nacional de Perinatología. Ginecol Obstet Mex 1995;63:478-82.

4. García M, Romaguera RL, Gómez-Fernández C. A hydatiform mole in a postmenopausal woman. A case report and review of the literature. Arch Pathol Lab Med 2004;128:1039-42.

5. Parazzini KF, LaVecchia C, Mangili G, et al. Dietary factors and risk of trophoblastic disease. Am J Obstet Gynecol 1988;158:93-99.

6. Kohorn EI, Goldstein DP, Hancock BW, et al. Combining the stage system of the Internacional Federation of Gynecology and Obstetric with the scoring system of the World Health Organization for trophoblastic neoplasia. Report of the working committee of the International Society for the Study of Trophoblastic Disease and International Gynecologic Cancer Society. Int J Gynecol Cancer 2000;10:84-88.

7. Ranf B, Hassan L, Ahmed S. Management of gestational trophoblastic tumors: a five year clinical experience. J Coll Physicians Surg Pak 2004;14:540-4.

8. Parazzini KF, LaVecchia C, Pampallona S. Parental age and risk of complete and partial hydatiform mole. Br J Obstet Gynaecol 1986;93:582-5.

9. Acaia B, Parazzini KF, LaVecchia C, et al. Increased frequency of complete hydatiform mole in women with repeated abortion. Gynecol Oncol 1988;32:310-4.

10. Goldstein DP, Berkowitz RS. Current management of complete and partial molar pregnancy. J Reprod Med 1994;39:139-46.

11. Feldman S, Goldstein DP, Berkowitz RS. Low risk metastatic gestational trophoblastic tumors. Semin Oncol 1995;22:166-71.

12. Wong LC, Choo YC, Ma HK. Primary oral etoposide therapy in gestational trophoblastic disease. An update. Cancer 1986;58:14-17.

13. Dobson LS, Lorigan PC, Coleman RE, et al. Persistent gestational trophoblastic disease: results of MEA (methotrexate, etoposide and dactinomycin) as first-line chemotherapy in high risk disease and EA (etoposide and dactinomycin) as second-line therapy for low risk disease. Br J Cancer 2000;82:1547-52.

14. Berkowitz RS, Bernstein MT, Laborde O, et al. Subsequent pregnancy experience in patients with gestational trophoblastic disease. New England Trophoblastic Disease Center 1965-1992. J Reprod Med 1994;39:228-32.

15. Song HZ, Wu PC, Wang Y, et al. Pregnancy outcome after successful chemotherapy for choriocarcinoma and invasive moles: long term follow-up. Am J Obstet Gynecol 1988;158:538-45.

16. Hammond CB, Borchert LG, Tyrey C, et al. Treatment of metastatic trophoblastic disease: good and poor prognosis. Am J Obstet Gynecol 1973;115:4-7.

17. Curry SL, Blessing JA, DiSaia PJ, et al. A prospective randomized comparison of methotrexate, dactinomycin and chlorambucil versus methotrexate, dactinomycin, cyclophosphamide, doxorubicin, melphalan, hydroxyurea, and vincristine in “poor prognosis” metastatic gestational trophoblastic disease. A gynecologic oncology group study. Obstet Gynecol 1989;73:357-62.

18. Bower M, Newlands ES, Holden L, et al. EMA/CO for high-risk gestational trophoblastic tumors: results from a cohort of 272 patients. J Clin Oncol 1997;15:2636-43.

19. Theodore C, Azab M, Droz JP, et al. Treatment of high-risk gestational trophoblastic disease with chemotherapy combinations containing cisplatin and etoposide. Cancer 1989;64:1824-8.

20. Soper JT, Evans AC, Rodriguez G, et al. Etoposide-platin combination therapy for chemorefractory gestational trophoblastic disease. Gynecol Oncol 1995;56:421-4.

21. Soper JT. Identification and management of high-risk gestational trophoblastic disease. Semin Oncol 1995;22:172-84.

22. Tomoda Y, Arii Y, Kaseki S. Surgical indications for resections of pulmonary metastases of choriocarcinoma. Cancer 1980;46:2723-8.