High-risk gestational trophoblastic neoplasia with brain metastases: Individualized multidisciplinary therapy in the management of four patients

Background: Gestational trophoblastic disease is a spectrum of cellular proliferation arising from the placental villous trophoblast. Gestational triphoblastic neoplasia (GTN) is a collective term for GTD that invade locally or metastasize. GTD includes hydatidiform mole (complete and partial) and GTN include invasive mole, choricocarcinoma, placental site trophoblastic tumor and epitheliod trophoblastic tumor. Aim: To evaluate clinicopathological profile, treatment pattern and clinical outcome in patients with gestational trophoblastic neoplasia (GTN). Materials and Methods: Twelve cases of gestational trophoblastic neoplasia treated between 2012 to November 2015 in deptt of Radiotherapy – II, PGIMS, Rohtak were evaluated in this retrospective study. Data was analyzed on the basis of age, histopathology, stage, type of treatment received and treatment related toxicities. Disease free survival was estimated. Results: Out of 12 women 7 (58 %) had hydatidiform mole, 4 (33%) invasive mole and 01 (8%) had choriocarcinoma. All the cases were given chemotherapy. Two patients had low risk disease. Among high risk group seven patients had score of less than 7 and five patients had risk score of 7 or higher. Five patients were given single agent methotrexate, seven patients received multidrug regimens. All patients are on regular follow up. One patient (high risk group) expired as she did not receive treatment. Conclusion: GTN are rare and proliferative disorders with proper diagnosis and treatment most of the cases are amenable to treatment with favorable outcome.

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High-Risk Gestational Trophoblastic Neoplasia from a Homozygous NLRP7 Mutation

Gynecologic Oncology Reports ◽

10.1016/j.gore.2021.100803 ◽

2021 ◽

pp. 100803

Author(s):

Zachary A. Kopelman ◽

Erica R. Hope

Keyword(s):

High Risk ◽

Gestational Trophoblastic Neoplasia

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Prophylactic Cranial Irradiation for Patients With Locally Advanced Non–Small-Cell Lung Cancer at High Risk for Brain Metastases

Clinical Lung Cancer ◽

10.1016/j.cllc.2014.11.005 ◽

2015 ◽

Vol 16 (4) ◽

pp. 292-297 ◽

Cited By ~ 10

Author(s):

Henry S. Park ◽

Roy H. Decker ◽

Lynn D. Wilson ◽

James B. Yu

Keyword(s):

Lung Cancer ◽

High Risk ◽

Brain Metastases ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Locally Advanced ◽

Cranial Irradiation ◽

Prophylactic Cranial Irradiation ◽

Small Cell ◽

Small Cell Lung

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EMA-CO chemotherapy for high-risk gestational trophoblastic neoplasia: a clinical analysis of 54 patients

International Journal of Gynecological Cancer ◽

10.1111/j.1525-1438.2007.00999.x ◽

2008 ◽

Vol 18 (2) ◽

pp. 357-362 ◽

Cited By ~ 35

Author(s):

W.-G. Lu ◽

F. Ye ◽

Y.-M. Shen ◽

Y.-F. Fu ◽

H.-Z. Chen ◽

...

Keyword(s):

Risk Factors ◽

Survival Rate ◽

High Risk ◽

Complete Remission ◽

Univariate Analysis ◽

Significant Risk ◽

Clinical Analysis ◽

Secondary Malignancy ◽

Primary Therapy ◽

Gestational Trophoblastic Neoplasia

This study was designed to analyze the outcomes of chemotherapy for high-risk gestational trophoblastic neoplasia (GTN) with EMA-CO regimen as primary and secondary protocol in China. Fifty-four patients with high-risk GTN received 292 EMA/CO treatment cycles between 1996 and 2005. Forty-five patients were primarily treated with EMA-CO, and nine were secondarily treated after failure to other combination chemotherapy. Adjuvant surgery and radiotherapy were used in the selected patients. Response, survival and related risk factors, as well as chemotherapy complications, were retrospectively analyzed. Thirty-five of forty-five patients (77.8%) receiving EMA-CO as first-line treatment achieved complete remission, and 77.8% (7/9) as secondary treatment. The overall survival rate was 87.0% in all high-risk GTN patients, with 93.3% (42/45) as primary therapy and 55.6% (5/9) as secondary therapy. The survival rates were significantly different between two groups (χ2= 6.434, P = 0.011). Univariate analysis showed that the metastatic site and the number of metastatic organs were significant risk factors, but binomial distribution logistic regression analysis revealed that only the number of metastatic organs was an independent risk factor for the survival rate. No life-threatening toxicity and secondary malignancy were found. EMA-EP regimen was used for ten patients who were resistant to EMA-CO and three who relapsed after EMA-CO. Of those, 11 patients (84.6%) achieved complete remission. We conclude that EMA-CO regimen is an effective and safe primary therapy for high-risk GTN, but not an appropriate second-line protocol. The number of metastatic organs is an independent prognostic factor for the patient with high-risk GTN. EMA-EP regimen is a highly effective salvage therapy for those failing to EMA-CO.

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