[Gestational trophoblastic disease. Experience at National Institute of Cancerology]

Gestational trophoblastic disease represents a variety of conditions that include hydatiform mole and choriocarcinoma. The common manifestation is high levels of beta human chorionic gonadotropin. In Mexico the incidence of the disease is 2.5 per 1,000 pregnancies.

This is a retrospective and descriptive analysis of patients with partial, complete or persistent hydatiform mole or choriocarcinoma diagnosis made from January 1988 to December 2003. We studied demographic characteristics, risk groups, treatment and response. We used descriptive statistics, multivariate analysis and Kaplan-Meier method for the survival analysis.

We found 71 cases, the mean age at diagnosis was of 26 years, and 60.6% had choriocarcinoma. Vaginal bleeding was the most common manifestation at diagnosis. Thirty patients had low risk disease and 25 of them received chemotherapy based in methotrexate and folinic acid, 88% had complete response. In 10% of the cases the use of salvage chemotherapy showed a complete response. Overall survival was 100% at five years. Forty-one cases belonging to intermediate and high risk group were treated with chemotherapy (etoposide and actinomycin D in 68.3%). Overall response was of 90.2%, with complete response in 58.5% and partial response in 33.3%. Overall survival was of 94% at five years. Two cases developed second malignancies secondary to etoposide.

Our results are similar to those reported in the literature. Overall survival in the low risk group was 100% and in the intermediate and high risk group of 94%. Etoposide and actynomicine D as first line chemotherapy had comparable results to those reported with EMA-CO and MAC.