International Journal of Hematology and Oncology 2019, Vol 29, Num 3 Page(s): 168-175
Retrospective Analysis of Gestational Trophoblastic Neoplasia: Single Center Experience

Veli SUNAR1, Vakkas KORKMAZ2, Zafer ARIK3, Bulent OZDAL2, Yaprak ENGIN USTUN4

1University of Health Sciences, Zekai Tahir Burak Women’s Health Training and Research Hospital, Medical Oncology Clinic, Ankara, TURKEY
2University of Health Sciences, Zekai Tahir Burak Women’s Health Training and Research Hospital, Gynecologic Oncology, Ankara, TURKEY
3Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, TURKEY
4University of Health Sciences, Zekai Tahir Burak Women’s Health Training and Research Hospital, Obstetrics and Gynecology Department, Ankara, TURKEY

Keywords: Gestational Trophoblastic Neoplasia, Methotrexate, Trophoblastic Disease, actinomycin D, EMA-CO protocol
This study aims to analyze the clinicopathologic characteristics and treatment outcomes of our patients with gestational trophoblastic neoplasia (GTN) and to present our real-life experience. A total of 32 patients with GTN diagnosed according to the FIGO 2002 criteria followed in Zekai Tahir Burak Women’s Health Training and Research Hospital between 2011-2018 were included. Demographic features, treatment outcomes, and survival were analyzed retrospectively. The median follow up time was 32.1 (3.3-76.9) months. Of the 32 patients, 27 (84.4%) were defined as low-risk GTN (risk score < 7) and 5 (15.6%) were high-risk GTN (risk score ≥ 7) according to the FIGO risk score. Seventeen (62.9%) patients with low-risk GTN achieved complete remission (CR) with single agent MTX. CR rate was 60% (12/20) in patients receiving weekly MTX and 71.4% (5/7) in MTX-FA eight-day regimen (p= 0.590). Of the 9 MTX resistant patients, 8 (88.8%) achieved CR with second-line Actinomycin D (ActD). Three (60%) out of the five high-risk GTN patients acquired CR with first-line EMA-CO (etoposide, MTX, plus ActD alternating with cyclophosphamide and vincristine). In the follow-up period one patient (3.1%) had recurrent disease. By the data cut off date, all of the patients were alive and CR could not be achieved in one (3.1%) patient. All patients with low-risk GTN achieved CR with sequential therapies ultimately. Therefore, single agent MTX is a reasonable option in the initial treatment of low-risk GTN. Moreover, Actinomycin D is highly effective in patients with low-risk GTN who are resistant to MTX.