ABSTRACT Introduction: Gestational trophoblastic neoplasia (GTN), is recognized as the most curable gynaecologic malignancy. However, many cases are resistant to first line chemotherapy. Objective: The aim of the study is to report our 5 years experience in the management of GTN cases with special stress on the chemo-resistant cases. Methods: The study was performed through reviewing the records of 51 patients who were diagnosed as GTN during the period from 1/1/2006 to 31/12/2010 in Mansoura University Hospital, Egypt. Results: Resistance to methotrexate therapy was reported in 15.15% of low risk cases and received etoposide or cisplatinum/etoposide. Sixty percent of high risk cases were resistant to MAC combination and received salvage chemotherapy or hysterectomy. There was significant correlation between patient response and initial B-hCG, as well as WHO risk score (P value = 0.001 in both) but correlations with age, parity, type of antecedent pregnancy, and histopathology were non significant (p = 0.95, 0.53, 0.47& 0.83 respectively). Conclusion: Low risk GTN cases who were resistant to methotrexate monotherapy received etoposide or cisplatinum/etoposide as a second-line therapy. High risk GTN cases who were resistant to MAC combination received second-line combination chemotherapy and/or hysterectomy. WHO risk score and initial B-hCG were correlated to resistance to first line chemotherapy.
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nullHemida, R. , Toson, E. , Shalaby, H. , Refaie, E. and Eldin, D. (2011) Chemo-resistant gestational trophoblastic neoplasia, 5-years experience of Mansoura University Hospital, Egypt. Open Journal of Obstetrics and Gynecology, 1, 153-157. doi: 10.4236/ojog.2011.13029.
 Disaia, P.J. and Creasman, W.T. (2007) Gestational trophoblastic neoplasia, 7th Edition. Clinical Gynaecologic Oncology, Mosby Inc, I, 201-233.
Berkowitz, R.S. and Goldstein, D.P. (2009) Current management of gestational trophoblastic diseases. Gynecologic Oncology, 112, 654-662.
Moodley, M., Tunkyi, K. and Moodley J. (2003) Gestational trophoblastic syndrome: An audit of 112 patients. A South African experience. International Journal of Gynecological Cancer, 13, 234-239.
Bagshawe, K.D., Dent, J., Newlands, E.S., Begent, R.H.J. and Rustin, G.J.S. (1989) The role of low-dose methotrexate and folinic acid in gestational trophoblastic tumors. British Journal of Obstetrics and Gynecology, 96, 795-802. doi:10.1111/j.1471-0528.1989.tb03318.x
Homesley, H.D., Blessing, J.A., Rottenmaier, M., Capizzi, R.L., Major, F.J. and Twiggs, L.B. (1988) Weekly intramuscular methotrexate for nonmetastatic gestational trophoblastic disease. Obstetrics and Gynecology, 72, 413-418.
McNeish, I.A., Strickland, S., Holden, L., et al. (2002) Low-risk persistent gestational trophoblastic disease: Out-come after initial treatment with low-dose methotrexate and folinic acid from 1992-2000. Journal of Clinical Oncology, 20, 1838-1844.
Bower, M., Newlands, E.S., Holden, L., et al. (1997) EMA/CO for high-risk gestational trophoblastic tumours: Results from a cohort of 272 patients. Journal of Clinical Oncology, 15, 2636-2643.
Newlands, E.S., Mulholland, P.J. and Holden, l., et al. (2000) Etoposide and cisplatin/etoposide, methotrexate, and actinomycin D (EMA) chemotherapy for patients with high-risk gestational trophoblastic tumors refractory to EMA/cyclophosphamide and vincristine chemotherapy and patients presenting with metastatic placental site trophoblastic tumors. Journal of Clinical Oncology, 18, 854-859.
El-Lamie, I.K., El Sayed, H.M., Badawie, A.G., Bayomi, W.A., El-Ghazaly, H.A., Khalaf-Allah, A.E., HEl-Mahallawy, M.N. and El-Lamie, K.I. (2006) Evolution of treatment of high-risk metastatic gestational trophoblastic tumors: Ain shams university experience. International Journal of Gynecological Cancer, 16, 866-874.
Deng, L., Yan, X., Zhang, J. and Wu, T. (2009) Combination chemotherapy for high-risk gestational trophoblastic tumour. Cochrane Database of System Reviews, 15, CD-005196.
Patel, S.M. and Desai, A. (2010) Management of drug resistant gestational trophoblastic neoplasia. The Journal of Reproductive Medicine, 55, 296-300.
Zhou, Y., Feng, F.Z., Xiang, Y. and Wan, X.R. (2010) Clinical analysis of patients with relapsed and chemoresistant gestational trophoblastic neoplasia. Chinese Journal of Obstertrics and Gynecology, 45, 804-807.
Ngan, S. and Seckl, M.J. (2007) Gestational trophoblastic neoplasia management: An update. Current Opinion in Oncology, 19, 486-491.
Kaye, D.K. (2002) Gestational trophoblastic disease following complete hydatidiform modle in Mulago Hospital, Kampala, Uganda. African Health Science, 2, 47-51.
Sebire, N.J. and Seckl, M.J. (2008) Gestational trophoblastic disease: Current management of hydatidiform mole. British Medicine Journal, 337, 1193.
Kuyumcuoglu, U., Guzel, A., Erdemoglu, M. and Celik Y. (2011) Risk factors for persistent gestational trophoblastic neoplasia. Journal of Experimental Therapeutics and Oncology, 9, 81-84.
Pongsaranantakul, S. and Kietpeerakool, C. (2009) Hysterectomy in gestational trophoblastic neoplasia: Chiang mai university hospital experience. Asian Pacific Journal of Cancer Prevention, 10, 311-314.
Sebire, N.J. and Lindsay, I. (2010) Current Issues in the histopathology of gestational trophoblastic tumors. Fetal and Pediatric Pathology, 29, 30-44.
Kumar, J., Ilancheran, A. and Ratnam, S. (1988) Pulmonary metastases in gestational trophoblastic disease: A review of 97 cases. British Journal of Obstetrics and Gynaecology, 95, 70-74.
Bagshawe, K.D. (1976) Risk and prognostic factors in trophoblastic neoplasia. Cancer, 38, 1373-1385.
Deligdisch, L., Driscoll, S.G. and Goldstein, D.P. (1978) Gestational trophoblastic neoplasms: Morphologic correlates of therapeutic response. American Journal of Obstetrics and Gynecology, 130, 801-806.
Wang, J., Short, D., Sebire, N., Lindsay, I., Newlands, E., Schmid, P., Savage, P. and Seckl, M. (2008) Salvage chemotherapy of relapsed or high-risk gestational trophoblastic neoplasia (GTN) with paclitaxel/cisplatin alternating with paclitaxel/etoposide (TP/TE). Annals of Oncology, 19, 1578-1583. doi:10.1093/annonc/mdn181
Fulop, V., Szigetvri, I., Szepesi, J., Torok, M. and Berkowitz, R.S. (2008) Diagnosis and treatment of high-risk metastatic gestational trophoblastic neoplasia in Hungary. Journal of Reproductive Medicine, 53, 541-546.