Assessment of the response to chemotherapy in gestational trophoblastic neoplasia with vaginal metastases |
| |
| Authors: | Ghaemmaghami Fatemeh Behroozi Shohreh Mousavi Azamolsadat Ashrafgangooei Tahereh Modares Gilani Mitra Behtash Nadereh Ghanbari Zinat |
| |
| Institution: | (1) Gynecology Oncology Department, Tehran University of Medical Sciences, Tehran, Iran;(2) Gynecology and Obstetrics Resident, Tehran University of Medical Sciences, Tehran, Iran;(3) Gynecology Oncology Department, Kerman University of Medical Sciences, Tehran, Iran;(4) Gynecology and Obstetrics Department, Tehran University of Medical Sciences, Tehran, Iran;(5) Gynecology Oncology Department, Vali-e-Asr Hospital, Imam Khomeini’s Hospital Complex, Keshavarz Blvd, Tehran, Iran |
| |
| Abstract: | Background and goals This study is designed to survey gestational trophoblastic neoplasia with vaginal metastases (GTN + VM) manifestations, prognosis
and chemotherapy response in order to consider appropriate chemotherapy regimen for these patients. There have been just a
few studies about treatment of GTN + VM.
Materials and methods Patients with Stage III GTN with or without vaginal metastases who had referred to Vali-e-Asr Hospital during 1996–2006 have
been selected to take part in this study and the size of metastases was measured. Then response and resistance to single and
combination chemotherapy regimens have been compared in these two groups. The data were processed using SPSS system (release
10). Statistical analysis was done with X2 to determine factors associated with complete clinical response. The level of significance was assigned at P < .05.
Results Forty-eight patients with stage III (with pulmonary metastases) GTN patients have been selected, 13 with vaginal metastases
and 35 without vaginal metastases. Incidence of vaginal metastases in stage III was 26%. Metastases were mainly in distal
part of vagina and suburethra. Chief complaint was severe hemorrhage in 25% of patients and was controlled by vaginal packing
with just one exception. Group of vaginal metastases showed 66.6% resistance to first-line chemotherapy, compared to 28.6%
in patients with no vaginal metastases (P-value = 0.010). Median of chemotherapy courses in low-risk vaginal metastatic patients was 5 (mean = 5.2), compared to three
courses in the group without vaginal metastases. Resistance to single chemotherapy was significantly higher in GTN + VM versus
GTN without VM patients and resistance was higher especially in patients with metastases with more than 3 cm (in diameter).
Conclusions Vaginal metastasis with more than 3 cm in diameter is an important prognostic factor in GTN patients. There have higher risks
for severe hemorrhage and resistance to single agent chemotherapy, so in these patients combination chemotherapy, with no
regard to staging and scoring, would be a better choice.
An erratum to this article can be found at |
| |
| Keywords: | Gestational trophoblastic disease Vaginal metastases Scoring system Chemotherapy Response |
| 本文献已被 PubMed SpringerLink 等数据库收录！ |
|
