GESTATIONAL TROPHOBLASTIC TUMORS - SITUATION ANALYSIS IN A THIRD-WORLD REGIONAL CANCER CENTER

A retrospective analysis of 128 cases of gestational trophoblastic tum or (GTT), registered between the years 1980 and 1993 was undertaken. A s per the WHO scoring system, 35 (27.3%) were classified as low risk ( LR), 32 (25%) as medium risk (MR) and 61 (47.6%) as high risk (HR). Ni nety-five of 128 (34 LR, 24 MR and 37 HR) cases were considered evalua ble for the purpose of treatment analysis. Complete remission (CR) was achieved in 100%, 83.3% and 83.7% of the LR, MR and HR categories res pectively. While three patients were cured with surgery alone (one LR, two MR), 60/92 (26/33 LR, 13/22 MR and 21/37 HR) responded to first l ine chemotherapy, 22/92 (eight LR, five MR and 10 HR) were salvaged wi th alternative chemotherapy regimens and 10/92 (four MR and six HR) ha d progressive disease. There were four recurrences, all in the HR grou p, who could not be salvaged. It appears that at least two cycles shou ld be administered as consolidation chemotherapy following CR, as recu rrent disease (RD) was observed in 3/6 HR patients receiving one or no cycle and 1/25 HR patients receiving two or more cycles of consolidat ion chemotherapy (P = 0.05). Three of six HR patients with CR and WHO score > 14 developed RD as compared to 1/25 HR patients with CR and WH O score < 15 (P < 0.001). The univariate analysis of the various progn ostic factors in the HR cases revealed that the initial chemotherapeut ic regimen was the most important prognostic factor.