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#380 Ultra high-risk gestational trophoblastic neoplasia: retrospective study of a single cohort at san raffaele scientific institute, milan-italy
  1. Giulia Sabetta,
  2. Alice Bergamini,
  3. Raffaella Cioffi,
  4. Costanza Saponaro,
  5. Emanuela Rabaiotti,
  6. Francesca Maria Vasta,
  7. Elisa Grassi,
  8. Giorgio Candotti and
  9. Giorgia Mangili
  1. IRCCS San Raffaele Scientific Institute, Milan, Italy


Introduction/Background Gestational trophoblastic neoplasia (GTN) with score >12 represents ultra-high-risk-GTN. Study investigates characteristics, treatment and outcome.

Methodology 14 ultra-high-risk-GTN patients, collected between January 1996 and October 2022, have been analyzed with descriptive statistics.

Results All patients were diagnosed with choriocarcinoma. Average age was 36 years, 28.6% were older than 40. All were symptomatic. Metrorrhagia was present in 57%. 78.6% had systemic symptoms, of these 55% had more than one symptom. 57% had respiratory distress, 14.3% hemorrhagic shock for rupture of arteriovenous-malformations (AVMs), 21.4% hyperthyroidism, 14.3% neurological symptoms, 21.4% hypertension, of these, one with chest pain and another with nephrotic syndrome and hypercalcemia, 14.3% gastrointestinal symptoms and two patients with kidney failure. Average serum β-sub-unit human-chorionic-gonadotropin (β-hCG) was 9773643 IU/L (477–3000000). Antecedent pregnancy was a term in 9(64.3%). Time interval from antecedent pregnancy was ≥12 months in 50%. All had lung metastases and 11(78.6%) brain and/or liver metastases. Average FIGO (International Federation Gynecology Obstetrics) score was 16 (14–18). 9(64.3%) were treated with EMA/CO (etoposide-methothrexate-dactinomicyn/cyclophosphamide-vincristine) while 1(7.1%) was treated with EP/EMA (etoposide-cisplatin/EMA and 4(28.6%) with EP/EMA with high-dose of methotrexate. From 1996 to 2004 patients did not induction with low-dose etoposide-cisplatin (EP), (7 patients). One patient died after first chemotherapy cycle. 4 received a second line for resistance development and one of them performed a third line for progression but died during treatment. All had alopecia and myelosuppression after each chemotherapy. After 2004, of 7 patients who performed EP-induction. All had alopecia and myelosuppression, 4 had oral mucositis of which one needed parenteral nutrition and had to change treatment. A patient developed corticosteroid-psychotic-disorder and another Posterior-Reversible-Encephalopathy-Syndrome-(PRES). One had disease progression, deceased from rupture of pulmonary AVMs.

Conclusion Ultra-high-risk-GTN is a systemic pathology such as to require medical observation both at diagnosis and during treatment. Standard regimen should be EMA/EP preceded by low-dose-EP.

Disclosures The authors declare no conflict of interest.

No financial disclosures to declare.

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