RT Journal Article
SR Electronic
T1 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
JF International Journal of Gynecologic Cancer
JO Int J Gynecol Cancer
FD BMJ Publishing Group Ltd
SP 1424
OP 1428
DO 10.1111/IGC.0b013e3181f5873e
VO 20
IS 8
A1 Woo Dae Kang
A1 Cheol Hong Kim
A1 Moon Kyoung Cho
A1 Jong Woon Kim
A1 Hye Yon Cho
A1 Yoon Ha Kim
A1 Ho Sun Choi
A1 Seok Mo Kim
YR 2010
UL http://ijgc.bmj.com/content/20/8/1424.abstract
AB 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.