Deaths from gestational trophoblastic neoplasia: any lessons to be learned?

To review retrospectively the causes of death in unselected patients with gestational trophoblastic neoplasia (GTN).

Between 1975 and 2010, 905 patients with GTN were treated at the Sheffield Centre. Twenty-four of them died. The medical records of these patients were reviewed.

Of the 24 patients, 11 died during initial treatment. A further 8 died from disease relapse and progression of the disease. The cause of death was unrelated in the other 5, who were excluded from analysis. For the remaining 19 patients, death was due to metastatic tumor in 13 and was treatment related in 6. Adverse prognostic features for death from GTN included histology (7 were placental site trophoblastic tumor [PSTT]), risk score (15 were high risk) and chemotherapy resistance. All 5 of the patients who died of acute treatment-related complications (invariably sepsis and/or multiorgan failure) still had active GTN at the time of death; all were treated prior to 1987. One multitreated patient died of acute myeloid leukemia 3 years posttreatment.

Metastatic multidrug-resistant PSTT was and still is the single most important cause of death. Death from choriocarcinoma was with nonpulmonary metastases not responding to initial treatment. Early treatment-related death (from sepsis) is nowadays avoidable.