Response of single-agent versus combination chemotherapy in patients of high-risk, non-metastatic gestational trophoblastic neoplasia = Response of single-agent versus combination chemotherapy in patients of high-risk, non-metastatic gestational trophoblastic neoplasia

다국어 초록 (Multilingual Abstract)

Women with stage 1 gestational trophoblastic disease (GTN) were usually treated with single-agent chemotherapy following 2004 ACOG guideline. Some of them were scored as high-risk group by FIGO system and we experienced frequent recurrence in them. And there are no clear guideline for high-risk stage 1 GTN. Here we want to compare outcomes between single-agent versus combination chemotherapy in non-metastatic, high-risk GTN. We retrospectively reviewed all non-metastatic, high-risk GTN patients treated with chemotherapy between 1998 and 2010 in single institute. 5 patients are treated with combination chemotherapy (EMA-CO) and 5 patients are treated with single-agent chemotherapy (Dactinomycin). Adjuvant surgery was performed in selective patients. Response to chemotherapy and other clinical outcomes were analyzed retrospectively. Age, parity, pretreatment b-hcg, initial tumor size measured by sonography, interval months from index pregnancy between two groups were not statistically different. The failure rate of single-agent chemotherapy using dactinomycin in high-risk, non-metastatic GTN was 60% (3/5), compared to 0% (0/5) of combination chemotherapy. (p=0.038). Patients resistant to single-agent therapy were treated with EMA-CO regimen, and all of them are cured so far (mean follow-up month: 40.6). Risk of hysterectomy is 60% (3/5) in single-agent group and 20% (1/5) in combination group (p=0.058). Severity of neutropenia and anemia during 1st line chemotherapy were similar in both groups. Even in stage 1 GTN, high risk groups might be initially treated with combination chemotherapy to avoid unnecessary additional chemotherapy and operation. Prognostic scoring system is considered more important than anatomic staging system to establish treatment plan in. Retrospective study with more numbers are needed to confirm the superiority of combination chemotherapy in stage 1, high risk GTN patients.