Introduction/Background For treatment of GTN patients at old age; there is an ongoing debate about performing upfront hysterectomy to reduce tumor bulk or starting chemotherapy.
Methodology A retrospective analysis of data from 5 referral centers from 5 countries (Egypt, Canada, Ukraine, Saudi Arabia, and Indonesia) during last 5 years. Medical records of 119 women with GTN were retrieved, reviewed and analyzed. Demographic criteria and outcome of different treatment strategies were evaluated.
Results Mean age was 45.46 years, and median hCG was 1390.5 m.IU/ml. Low-risk GTN represented 81.5% of cases while 18.5% were in high-risk group. Most of the patients were in FIGO stage I (76.2%). Metastases were diagnosed in 28 cases (23.5%), lungs were commonest site. The commonest histopathological type was invasive mole (38.1%). Of 80 patients with low risk non metastatic GTN, 32 women were treated with single chemotherapy. Eighteen of them (56.2%) showed complete response while relapse was reported in one case. In 34 cases a hysterectomy was performed. In four; a wait and see policy was adopted while instant chemotherapy followed in 30, mainly single MTX for 1-12 courses. Only one case 1/34 (3%) failed to respond. Of 14 patients with low risk metastatic GTN, 8 women were treated with single chemotherapy while in 6 patients a hysterectomy was performed and MTX was started immediately in all. Complete response occurred only in 7/14 (50%). Two high risk patients died before treatment could start due to presence of distant metastases. Eleven cases had underwent hysterectomy and chemotherapy as first line; 7/11 showed complete response. Four women used EMA/CO combination chemotherapy alone; two of them (50%) had incomplete response and needed 2nd line EMA/EP combination.
Conclusion Upfront hysterectomy for treatment low-risk non-metastatic disease and combination chemotherapy for high-risk disease were associated with better prognosis.
Disclosure Nothing to disclose.
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