MANAGEMENT OF HIGH-RISK GESTATIONAL TROPHOBLASTIC DISEASE - THE MEMORIAL HOSPITAL EXPERIENCE

Thirty-two patients with high-risk gestational trophoblastic disease ( GTD), defined as metastases to the brain or liver (regardless of hCG l evel or duration of disease) or prior unsuccessful chemotherapy are re viewed. In this classification, an antecedent term pregnancy is not co nsidered to be an independent high-risk factor. Initial chemotherapy i n 15 (46.8%) patients consisted of methotrexate, actinomycin D, and ch lorambucil (MAC), actinomycin D alone in seven (21.8%), etoposide, met hotrexate, actinomycin D, cytoxan on covin (EMACO) EMACO in three (9.4 %), ITMA (hydroxyurea, vincristine, methotrexate, folinic acid, cyclop hosphamide, actinomycin D, adriamycin, and melphalan) in three (9.4%). The remaining patients were treated with actinomycin D and 6-mercapto purine (1), CHAMOCA (1), carboplatin and Taxol (1), and methotrexate ( 1). All patients with brain metastases were treated with cranial radio therapy. Overall complete remission was achieved in 14 of 32 (43.7%) p atients. Five of 9 (55.5%) patients whose disease followed a term preg nancy survived compared to nine of 23 (39.1%) patients whose disease f ollowed other types of pregnancies. The data analyzed according to the clinical classification of 'high-risk' indicates that an overall surv ival rate of 70% was achieved. The Memorial Hospital classification th erefore identifies patients who need primary chemotherapy more aggress ive than MAC and similar to the WHO scoring system is a better predict or of survival than the clinical classification.