Management of low-risk gestational trophoblastic neoplasia in indigent women
John O Schorge1, Jayanthi S Lea, Diana F Farrar
1Southwestern Trophoblastic Disease Center, Division of Gynecologic Oncology, Dep. of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, 75390-9032, USA. john.schorge@utsouthwestern.edu
Objective:
To identify the most effective dosing regimen for indigent patients with low-risk gestational trophoblastic neoplasia (GTN) at high risk of noncompliance.
Study Design:
All women primarily treated for GTN at our public hospital between November 1990 and November 2001 were prospectively entered into a database. Patients were treated with either (1) methotrexate, 100 mg/m2, intravenous bolus, followed by a 12-hour infusion, 200 mg/m2 (regimen 1); (2) methotrexate, 0.4 mg/kg/m2 intramuscularly for 5 consecutive days on alternating weeks (regimen 2); or (3) methotrexate, 30-50 mg/m2 intramuscularly weekly (regimen 3). Medical records were reviewed to obtain clinical data, and statistical analysis was performed.
Results:
Thirty-two women were treated for low-risk GTN. The median age at diagnosis was 22 years (range, 15-40). Patients receiving regimen 1 (5/5, 100%) and 2 (19/20, 95%) were more likely to achieve complete remission without switching to dactinomycin or combination chemotherapy than those receiving regimen 3 (3/7, 43%; P < .001). Regimen 1 required fewer median treatment cycles (1.0, P = .04) than regimens 2 (6.5 cycles) and 3 (8.0 cycles). Seventeen (52%) patients were noncompliant with the chemotherapy protocol and/or posttreatment surveillance.
Conclusion:
A 1-day methotrexate infusion is highly effective for treating indigent women with low-risk. GTN.