[Chemotherapy of high-risk trophoblastic neoplasia]

With recent progress in chemotherapy, the prognosis of patients with trophoblastic neoplasia has greatly improved, but the remission rate of patients with choriocarcinoma remains unfavorable. The Committee for Trophoblastic Disease of the Japan Society of Obstetrics and Gynecology reported the results of hospital registration at 77 institutions throughout Japan in 1987. In this report, the survival rates of patients treated during the 7 years from 1974 to 1980 were described as follows. The 5-year survival rate has approached 100% for patients with invasive mole, while the rate for patients with choriocarcinoma is now approaching 80%. As far as choriocarcinoma is concerned, the survival rate depends on the presence of metastases. The 5-years survival rate for patients without metastases has approached 100%, while that for patients with metastases is barely 60%. Patients with poor-prognosis choriocarcinoma present difficult and challenging problems for the clinician. These patients are best treated on the basis of the prognostic scoring system proposed by Bagshawe. The higher the score, the greater the risk of drug resistance developing during traditional therapy. To date, our experience with the MECA regimen would indicate that it is most effective for patients with high-risk trophoblastic neoplasia. We now also recommend that all high-risk patients should receive at least four additional courses of the regimen after a negative hCG titer has been obtained. After complete remission has been achieved, further follow up should be repeated every month for at least three years.