Prolonged remission of recurrent, metastatic placental site trophoblastic tumor after chemotherapy

Background. Placental site trophoblastic tumor (PSTT) is a form of gestatio nal trophoblastic neoplasm that is frequently resistant to chemotherapy. In most cases disease is confined to the uterus and can be cured by curettage or simple hysterectomy. Patients with metastases, however, frequently have progression of disease and die despite aggressive multiagent chemotherapy. Case. A 31-year-old woman was found on review of uterine curettings to have a PSTT. Imaging studies revealed multiple lung lesions, a liver lesion, an d an enlarged irregular uterus. Hysterectomy and staging surgery revealed a large tumor in the endometrial cavity and multiple metastases. She was tre ated with etoposide-methotrexate-dactinomycin and cyclophosphamide-vincrist ine and had a complete clinical remission. Six months later, however, she h ad a recurrence. She was then treated with six cycles of etoposide-methotre xate-dactinomycin and etoposide-cisplatin. Three years after completion of the second regimen she is without evidence of disease. Conclusion. Treatment with multiagent chemotherapy can produce long-term re mission, even in patients with recurrent, metastatic PSTT. Addition of plat inum may be helpful in patients who have recurred or progressed after treat ment with non-platinum-containing regimens. (C) 2000 Academic Press.