Article Text

Download PDFPDF
Serum hCG Level and Rising World Health Organization Score at Second-Line Chemotherapy (Pulse Dactinomycin): Poor Prognostic Factors for Methotrexate-Failed Low-Risk Gestational Trophoblastic Neoplasia
  1. Woo Dae Kang, MD, PhD,
  2. Cheol Hong Kim, MD, PhD,
  3. Moon Kyoung Cho, MD, PhD,
  4. Jong Woon Kim, MD, PhD,
  5. Hye Yon Cho, MD,
  6. Yoon Ha Kim, MD, PhD,
  7. Ho Sun Choi, MD, PhD and
  8. Seok Mo Kim, MD, PhD
  1. Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Republic of Korea.
  1. Address correspondence and reprint requests to Seok Mo Kim, MD, PhD, Department of Obstetrics and Gynecology, Chonnam National University Medical School, 8 Hakdong, Dong-gu, Gwangju, Republic of Korea. E-mail: seokmo2001{at}hanmail.net.

Abstract

Introduction: The aim of this study was to determine the factors associated with failure in patients receiving pulse dactinomycin as second-line chemotherapy for low-risk gestational trophoblastic neoplasia (GTN) according to the revised International Federation of Obstetrics and Gynecology 2000 scoring system at a single institution.

Methods: Between January 1997 and June 2007, 37 patients with methotrexate-failed low-risk GTN were treated with pulse dactinomycin (1.25 mg/m2 intravenously every 2 weeks). All patients had low-risk GTN based on the revised International Federation of Obstetrics and Gynecology 2000 scoring system at the time of second-line chemotherapy. A logistic regression model was used to analyze the relationship between covariates and treatment failure.

Results: There were 28 (75.7%) patients who achieved primary remission with pulse dactinomycin. All 9 treatment failures achieved complete remission after receiving subsequent chemotherapy; 1 patient also underwent hysterectomy. Patients successfully treated with pulse dactinomycin required a median of 4.0 cycles (range, 2-7) to achieve a complete response. The risk of failure with pulse dactinomycin was higher for serum hCG levels 103 or higher when initiating pulse dactinomycin (odds ratio, 8.91; 95% confidence interval, 1.08-73.53) and a rising World Health Organization score of 2 or higher after first-line chemotherapy (odds ratio, 12.59; 95% confidence interval, 1.60-99.25). With respect to the previous methotrexate regimen and cause of failed methotrexate chemotherapy, there were no differences between those who were successfully treated and those who failed pulse dactinomycin.

Conclusions: Serum hCG level and a rising World Health Organization score at the time of initiating pulse dactinomycin are important prognostic factors in patients with methotrexate-failed low-risk GTN receiving pulse actinomycin as second-line chemotherapy.

  • Dactinomycin
  • Gestational trophoblastic neoplasia
  • Low-risk
  • Methotrexate

Statistics from Altmetric.com

Footnotes

  • The authors declare that there are no conflicts of interest.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.