Evolution of treatment of high-risk metastatic gestational trophoblastic tumors: Ain Shams University experience | Semantic Scholar (2024)

GTNs have excellent prognosis if properly treated at experienced centers and single-agent dactinomycin seems more effective for low-risk GTN, which reflects the success of salvage therapy.

Low risk GTN cases who were resistant to methotrexate monotherapy received etoposid or cisplatinum/etoposide as a second-line therapy and high risk cases who was resistant to MAC combination received second- line combination chemotherapy and/or hysterectomy.

The overall survival rate in 804 patients with GTN treated from 1962 to 2006 was 93.3% and the cure rate for patients with metastatic disease increased from 77.8% during 1962–1978 to 91.8%) from 1979 to 2006.

The overall survival rate in patients with GTN treated at the John I. Brewer Trophoblastic Disease Center improved from 88.6% in 1962–1978 to 97.8% in 1979–2006.

Surgical management of chemotherapy-resistant GTN is reviewed, focusing on the relevant indication of surgery, factors affecting efficacy and the use of surgical procedures in selected patients.

This review covers the primary and relapse/resistant pharmacotherapy of both low- and high-risk GTN, with consideration of liver, CNS metastases and placental site trophoblastic tumor.

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It was found that only the presence of brain and/or liver metastases, followed by an antecedent nonmolar pregnancy and resistance to multiple agent chemotherapy were significant as regards the prognosis of high-risk metastatic GTT.

It seems that multi-agent chemotherapy (EMA-EP) concurrently with whole brain irradiation results in acceptable survival rates in GTT patients with brain metastases.

With appropriate management, the outlook for patients with brain metastases from high-risk gestational trophoblastic tumors is good, and the majority of patients achieved sustained remission and probably a cure with chemotherapy as the dominant form of treatment.

Factors relating to development and survival of recurrent disease include: poor prognosis metastatic disease, inadequate initial staging and therapy, lack of adequate maintenance chemotherapy beyond the first negative hCG level, and prolonged intervals between cycles of chemotherapy.

The EMA/EP regimen is effective for chemorefractory GTT, and the chemotherapeutic results can be improved when combined with surgery and arterial infusion chemotherapy in selected patients.

EMA/CO is an effective and well-tolerated regimen for high-risk GTT and more than half of the women will retain their fertility; however, there is a small but significant risk of second malignancy.

It appears that a select subset of patients with chemorefractory GTD who have a limited number of clinically detectable tumor foci may benefit from salvage surgery.

Although etoposide-containing chemotherapy is currently the most effective and well tolerated regimen for high-risk GTT, 20-30% of patients develop drug resistance to these regimens.

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