Low Risk Group Gestational Trophoblastic Diseases - A Study of 40 Cases

Abstract

This prospective study was done over 40 patients suffering from low risk gestational trophoblastic diseases (GTD) from January 2002 to December 2008 in the department of Radiotherapy , Dhaka Medical College Hospital and Mitford Hospital. They aged between 18 and 45 years, mean age 26.72 years with peak occurrence (70%) in the 3rd decade (21- 30 Years). Among the 40 cases, one belonged to FIGO score- 1, eight to FIGO score-2, twenty to score-3 and 11 to score- 4. Only eight patient presented with beta-hCG above 100000u/ml.

All the patients were planned for two weekly chemotherapy with methotrexate and leucovorin (methotrexate - 1mg/kg IV/IM on day 1,3,5,7 and oral leucovorin -0.1mg/kg on day 2,4,6,8) and were continued until beta-hCG level comes down to normal range. Then another three cycles of same chemotherapy were given. Two patients dropped during the course of chemotherapy.

Chemotherapy schedule was changed to five drug regimen, EMA-CO schedule (etoposide-100mg/m² on day-1&2, methotrexate-100mg/m² IV bolus and 200mg/m² IV drip day-1, actinomycin-D- 0.5mg/m² IV day-1&2, cyclophosphamide-600mg/m² day-8 and vincristine-1mg/ m² IV day-8) due to increase in beta-hCG titre during chemotherapy with methotrexate and leucovorin. Another patient became pregnant after completion of methotrexate plus leucovorin, delivered a healthy male baby and came to us with recurrence. He was also treated with EMA-CO schedule.

After completion of treatment, they were evaluated monthly for three months, three monthly for two years and then six monthly. Follow up period ranged between two to six years (median -four years). Among the 40 cases included in this study, two patients (5%) dropped during therapy, one (2.5%) expired due to post pregnancy recurrence and remaining 37 (92.5%) are yet in disease free state.

(Bang. Onc. J. 2009; 4(2) : 54-58)