Low-risk gestational trophoblastic neoplasia - 20 years experience of a state registry.
actinomycin D
gestational trophoblastic disease
methotrexate
registries
trophoblastic neoplasms
Journal
The Australian & New Zealand journal of obstetrics & gynaecology
ISSN: 1479-828X
Titre abrégé: Aust N Z J Obstet Gynaecol
Pays: Australia
ID NLM: 0001027
Informations de publication
Date de publication:
14 Nov 2023
14 Nov 2023
Historique:
received:
02
06
2023
accepted:
28
10
2023
medline:
15
11
2023
pubmed:
15
11
2023
entrez:
15
11
2023
Statut:
aheadofprint
Résumé
Gestational trophoblastic disease (GTD) is an uncommon but highly treatable condition. There is limited local evidence to guide therapy. To report the experience of a statewide registry in the treatment of low-risk gestational trophoblastic neoplasia (GTN) over a 20-year period. A retrospective review of the prospectively maintained GTD registry database was conducted. There were 144 patients identified with low-risk GTN, of which 115 were analysed. Patient demographics, treatment details and outcomes, including development of resistance, toxicity or relapse were reviewed. The incidence of GTD was 2.6/1000 live births. There was 100% survival. The mean time from diagnosis to commencing treatment was 1.9 days (range 0-29 days). Seventy-seven percent of patients treated with methotrexate achieved complete response. Thirteen patients (11.3%) required multi-agent chemotherapy, for the treatment of resistant or relapsed disease. There was a higher rate of treatment resistance in those with World Health Organization (WHO) risk scores 5-6 (odds ratio (OR) 6.56, 95% CI 1.73-24.27, P = 0.005) and those with pre-treatment human chorionic gonadotropin >10 000 (OR 4.00 95% CI 1.73-24.27 P = 0.007). Four patients (3.5%) were diagnosed with choriocarcinoma after commencing treatment. Nine patients (7.8%) had successful surgical treatment for GTN, both alone and in combination with chemotherapy. The relapse rate was 4.3%; all were treated successfully with a combination of chemotherapy and surgery, and 93.9% of patients completed follow up through the registry. Methotrexate is a highly effective treatment for low-risk GTN, especially with WHO risk score ≤4. The optimal treatment for those with risk scores of 5-6 requires further investigation.
Sections du résumé
BACKGROUND
BACKGROUND
Gestational trophoblastic disease (GTD) is an uncommon but highly treatable condition. There is limited local evidence to guide therapy.
AIMS
OBJECTIVE
To report the experience of a statewide registry in the treatment of low-risk gestational trophoblastic neoplasia (GTN) over a 20-year period.
MATERIALS AND METHODS
METHODS
A retrospective review of the prospectively maintained GTD registry database was conducted. There were 144 patients identified with low-risk GTN, of which 115 were analysed. Patient demographics, treatment details and outcomes, including development of resistance, toxicity or relapse were reviewed.
RESULTS
RESULTS
The incidence of GTD was 2.6/1000 live births. There was 100% survival. The mean time from diagnosis to commencing treatment was 1.9 days (range 0-29 days). Seventy-seven percent of patients treated with methotrexate achieved complete response. Thirteen patients (11.3%) required multi-agent chemotherapy, for the treatment of resistant or relapsed disease. There was a higher rate of treatment resistance in those with World Health Organization (WHO) risk scores 5-6 (odds ratio (OR) 6.56, 95% CI 1.73-24.27, P = 0.005) and those with pre-treatment human chorionic gonadotropin >10 000 (OR 4.00 95% CI 1.73-24.27 P = 0.007). Four patients (3.5%) were diagnosed with choriocarcinoma after commencing treatment. Nine patients (7.8%) had successful surgical treatment for GTN, both alone and in combination with chemotherapy. The relapse rate was 4.3%; all were treated successfully with a combination of chemotherapy and surgery, and 93.9% of patients completed follow up through the registry.
CONCLUSIONS
CONCLUSIONS
Methotrexate is a highly effective treatment for low-risk GTN, especially with WHO risk score ≤4. The optimal treatment for those with risk scores of 5-6 requires further investigation.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
Références
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 [Internet] 2021; 163(3): 605-613. https://doi.org/10.1016/j.ygyno.2021.10.003.
Abu-Rustum NR, Yashar CM, Bean S et al. Gestational trophoblastic neoplasia, version 2.2019. JNCCN J Natl Compr Cancer Netw 2019; 17(11): 1374-1391.
Ngan HYS, Seckl MJ, Berkowitz RS et al. Diagnosis and management of gestational trophoblastic disease: 2021 update. Int J Gynecol Obstet 2021; 155(S1): 86-93.
Yuk JS, Baek JC, Park JE et al. Incidence of gestational trophoblastic disease in South Korea: A longitudinal, population-based study. PeerJ 2019; 2019(2): 1-11.
Lund H, Vyberg M, Eriksen HH et al. Decreasing incidence of registered hydatidiform moles in Denmark 1999-2014. Sci Rep [Internet] 2020; 10(1): 1-10. https://doi.org/10.1038/s41598-020-73921-4.
Figo Oncology Committee. FIGO staging for gestational trophoblastic neoplasia 2000. Int J Gynecol Obstet 2002; 77(3): 285-287.
Government VS. Births Deaths and Marriages Victoria [Internet]. 2022 [cited 2021 Dec 12]. Available from: https://www.bdm.vic.gov.au/research-and-family-history/research-and-data-services.
Altman AD, Bentley B, Murray SBJ. Maternal age-related rates of gestational trophoblastic disease. Obstet Gynecol 2008; 112(2 Pt 2): 244-250.
Hao J, Zhou W, Zhang M et al. Direct comparisons of efficacy and safety between actinomycin-D and methotrexate in women with low-risk gestational trophoblastic neoplasia: A meta-analysis of randomized and high-quality non-randomized studies. BMC Cancer 2021; 21(1): 1-14.
Lawrie TA, Alazzam M, Tidy J et al. First-line chemotherapy in low-risk gestational trophoblastic neoplasia. Cochrane Database Syst Rev 2016; 2016(6): 1-17.
Schink JC, Filiaci V, Huang HQ et al. An international randomized phase III trial of pulse actinomycin- D versus multi-day methotrexate for the treatment of low risk gestational trophoblastic neoplasia. Gynecol Oncol 2020; 158(2): 354-360.
Verhoef L, Baartz D, Morrison S et al. Outcomes of women diagnosed and treated for low-risk gestational trophoblastic neoplasia at the Queensland trophoblast Centre (QTC). Aust New Zeal J Obstet Gynaecol 2017; 57(4): 458-463.
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 [Internet] 2021; 22(8): 1188-1198. https://doi.org/10.1016/S1470-2045(21)00262-X.
Chapman-Davis E, Hoekstra AV, Rademaker AW et al. Treatment of nonmetastatic and metastatic low-risk gestational trophoblastic neoplasia: Factors associated with resistance to single-agent methotrexate chemotherapy. Gynecol Oncol [Internet] 2012; 125(3): 572-575. https://doi.org/10.1016/j.ygyno.2012.03.039.
Lybol C, Sweep FCGJ, Harvey R et al. Relapse rates after two versus three consolidation courses of methotrexate in the treatment of low-risk gestational trophoblastic neoplasia. Gynecol Oncol [Internet] 2012; 125(3): 576-579. https://doi.org/10.1016/j.ygyno.2012.03.003.