Evaluation of the Relation between Treatment Results and Predictive Factors in Metastatic and High Risk Gestational Trophoblastic Neoplasia

High risk gestational trophoblastic neoplasia is considered a treatable malignancy due to recent advancements in chemotherapy. This report describes treatment outcomes as a predictor of prognosis in one institute.
We performed a retrospective analysis of the treatment results from 41 patients diagnosed with high risk and metastatic gestational trophoblastic neoplasia who received treatment at Mashhad University of Medical Sciences, Mashhad, Iran from January, 2008 to May, 2014.
Patients had a mean age of 31.31 years. Average treatment time was 3.5 months. Within the participants; 19 patients with World Health Organization scores over 7; received methotrexate at the first line of treatment. 11 cases (26.8%) of the 19 patients with single agent chemotherapy showed resistance. The patients who were resistant to treatment received a combination chemotherapy as the second line of treatment. The response rate of the etoposide, methotrexate, actinomycin D, cyclophosphamide and oncovin chemotherapy regimen as the first line of treatment was 93.7%, which decreased to approximately 83.3% when administered as the second line of treatment. There were 76.4% of cases in remission at the one year follow-up and a successful pregnancy rate of 17.5%. A statistically significant relation existed between chemotherapy response rate with disease stage, score, site, and number of metastases (P<0.05).
The World Health Organization/International Federation of Gynecology and Obstetrics staging-scoring system is appropriate for gestational trophoblastic neoplasia management. The etoposide, methotrexate, actinomycin D, cyclophosphamide, and oncovin regimen showed superior efficacy. The importance of accurate patient selection for adjuvant surgery in high risk gestational trophoblastic neoplasia cannot be emphasized.