November 29th, 2015

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The Changing Role of Thoracotomy in Gestational Trophoblastic Neoplasia at the New England Trophoblastic Disease Center
Authors:  Evelyn L. Fleming, M.D., Leslie Garrett, M.D., Whitfield B. Growdon, M.D., Michael Callahan, M.D., Nicole Nevadunsky, M.D., Sue Ghosh, M.D., Donald P. Goldstein, M.D., and Ross S. Berkowitz, M.D.
  OBJECTIVE: To review our experience with thoracotomy in gestational trophoblastic neoplasia (GTN).

STUDY DESIGN: Nineteen thoracotomy patients from our database were identified. Thoracotomy was performed for therapeutic reasons in 11 patients and to clarify the diagnosis in eight.

RESULTS: Among the 11 patients with chemotherapy-resistant pulmonary tumors, 10 of 11 (90.9%) achieved remission with thoracotomy. Thoracotomy was more likely to be done to clarify diagnosis before 1980 (83%) than after 1980 (23%) (p= 0.04), when it became more likely to be done for therapeutic indications. Ten patients had solitary lung lesions and 9 had multiple lesions. Four patients died (21%), with an average survival after thoracotomy of 149 days; patients had bilateral or multiple lung lesions, median preoperative hCG was 58,000 mIU/mL and all were stage IV. Survivors had lower stage disease, were more likely to have solitary lesions and had lower preoperative hCG levels.

CONCLUSION: There have been several temporal changes in the indications for thoracotomy for GTN. In general, the optimal patient to achieve remission with thoracotomy will have stage III disease, a preoperative hCG of <1,500 mIU/mL, and a solitary lung nodule resistant to chemotherapy. Likelihood of remission after thoracotomy is high in properly selected patients. (J Reprod Med 2008;53:493-498)
Keywords:  gestational trophoblastic neoplasms, thoracotomy
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