August 23rd, 2019

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Medical and Surgical Treatment for Postmolar Low-Risk Gestational Trophoblastic Neoplasia After Failure of Single-Agent Treatment
Authors:  Lei Li, M.D., Xirun Wan, M.D., Fengzhi Feng, M.D., Tong Ren, M.D., Junjun Yang, M.D., Jun Zhao, M.D., Fang Jiang, M.D., and Yang Xiang, M.D.
  OBJECTIVE: To determine the role of second-line therapy and surgical intervention in patients with low-risk postmolar gestational trophoblastic neoplasia (GTN) resistant to single-agent treat-ment.

STUDY DESIGN: From January 2013 to October 2016, 72 eligible patients were recruited and were followed until May 2017. Epidemiological, clinical, and survival data were compared to elucidate the roles of medical and surgical interventions.

RESULTS: Second-line regimens of EMA/CO (etoposide, methotrexate, actinomycin D/cyclophosphamide, vincristine), FAV (floxuridine, actinomycin D, and vincristine), and FAEV (FAV plus etoposide) were applied to 9, 53, and 10 patients and achieved remission rates of 88.9%, 75.5%, and 100%, respectively. EMA/CO and FAEV were associated with more severe adverse events than FAV. Total and second-line courses of chemotherapy before β-hCG levels normalized were independent risk factors predicting failure to second-line therapy. Twelve patients (16.7%) underwent hysterectomy or resection of invasive uterine lesions. Patients of surgeries had significantly more invasive uterine lesions and higher β-hCG levels but similar remission and relapse rates.

CONCLUSION: For patients with low-risk postmolar GTN resistant to single-agent treatment, second-line regimens had similar remission rates. More courses of chemotherapy indicated poor prognosis. Surgeries were applied to more critically ill patients.
Keywords:  adverse effects; antineoplastic combined chemotherapy protocols; drug resistance, neoplasm; gestational trophoblastic disease; gestational trophoblastic neoplasia; hysterectomy; molar pregnancy
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