CLINICAL OUTCOME OF MICROMETASTASIS IN THE LUNG IN STAGE IA PERSISTENT GESTATIONAL TROPHOBLASTIC DISEASE

Background. Computed tomography (CT) of the thorax can be used in the staging of persistent gestational trophoblastic disease (PGTD). Howeve r, the prognostic significance of micrometastasis in the lung detected by CT of the thorax has not been well documented. The aim of the stud y is to define the effect of micrometastasis on the clinical course of the disease. Methods. Thirty-five patients who had nonmetastatic GTD underwent CT thorax examination before treatment in the Department of Obstetrics and Gynaecology, University of Hong Kong. All patients had workups which showed no evidence of metastasis and were diagnosed as F IGO stage IA. They all received methotrexate (MTX) infusion therapy. R esults. Three groups of patients were identified based on the thorax C T findings. Sixteen patients (45.7%) showed no evidence of micrometast asis on CT thorax. Two of them (12.5%) had poor response to MTX with u nsatisfactory fall in serum hCG levels requiring change of chemotherap y to actinomycin D. Nine patients had suspicious micrometastasis and o ne (11.1%) of them needed change of MTX. Ten patients had micrometasta sis and one (10%) of them needed change of MTX. There was only one rec urrence and it was in the suspicious micrometastasis group (11.1%). Th ere was no statistically significant difference in the rate of poor dr ug response or recurrence among the three groups of patients. Conclusi ons. Micrometastases in the lung do not affect the clinical outcome of patients with FIGO stage IA disease. CT thorax is not essential in th e staging of GTD. (C) 1998 Academic Press.