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Published on: August 31, 2016
Minimally-aggressive gestational trophoblastic neoplasms.
1USA hCG Reference Service, Albuquerque, NM 87109, USA.
Gynecologic Oncology
|December 27, 2011
Summary
A new protocol for minimally aggressive gestational trophoblastic neoplasms, involving delayed chemotherapy until hCG levels rise, shows high success rates. This approach identifies the syndrome using hyperglycosylated hCG or hCG doubling time.
Area of Science:
- Gynecology
- Oncology
- Reproductive Endocrinology
Background:
- Minimally-aggressive gestational trophoblastic neoplasms (GNT) are characterized by slow growth and resistance to chemotherapy.
- A previously described protocol involved waiting for hCG rise to >3000 mIU/ml before initiating combination chemotherapy.
- Initial success was observed in 8 out of 8 cases, prompting further investigation.
Purpose of the Study:
- To evaluate the efficacy of the delayed chemotherapy protocol in a larger cohort of patients with minimally-aggressive GNT.
- To assess the utility of hyperglycosylated hCG and hCG doubling rate as diagnostic markers for this syndrome.
Main Methods:
- Minimally-aggressive GNT was identified using chemotherapy resistance, low hyperglycosylated hCG (<40% of total hCG), or an hCG doubling time greater than 2 weeks.
- Patients were advised to defer chemotherapy until hCG levels exceeded 3000 mIU/ml.
- Combination chemotherapy was administered upon reaching the specified hCG threshold.
Main Results:
- Nineteen new cases of minimally-aggressive GNT were identified using the proposed diagnostic criteria.
- Three patients were excluded from the study (one deceased, one with lung nodule, one refusing treatment).
- The remaining 16 patients were successfully treated with the delayed chemotherapy protocol.
Conclusions:
- The delayed chemotherapy protocol, initiated when hCG exceeds 3000 mIU/ml, demonstrated a 100% success rate in the studied cohort (16 out of 16).
- Combined with the initial 8 cases, a total of 24 out of 24 patients achieved successful treatment.
- The study supports the use of hyperglycosylated hCG and hCG doubling rate for identifying minimally-aggressive GNT and advocates for the delayed chemotherapy approach.
