Abstract
Introduction:
Gestational trophoblastic tumors (GTT) are the malignant forms of gestational trophoblastic diseases. They are rare tumors, generally chemosensitive and of excellent prognosis, thus requiring an early and adopted treatment. High-risk GTT (Figo score ⩾ 7) are treated with multi-agent chemotherapy with cure rates around 80%.
We report the experience of the medical oncology department of the National Institute of Oncology of Rabat – Morocco.
Material and methods:
This is a retrospective study evaluated over a period from January 2008 to May 2016, involving 27 cases of high-risk GTT. The patients were treated and followed at National Institute of Oncology of Rabat. It is a descriptive study based on the diagnostic and prognostic elements, the therapeutic modalities and the evolution of patients with high-risk GTT.
Results:
For the 27 patients, the average age was 33,65 with extreme ages of 19 and 51 years. The diagnosis was supported by a pelvic ultrasound associated with a plasmatic βHCG and confirmed histologically for all our patients. The presence of pelvic mass was noted in 51,85% of cases. An extension assessment was performed in all our patients, revealing metastases in 40,74% of cases, of which 37% were pulmonary metastases and 2,7% lymph node metastases.
All our patients were classified as high-risk according to the Figo score, which ranged between 7 and 13. Our patients were treated with multi-agent chemotherapy. They received EMA (Etoposide- Methotrexate-Actinomycin D) – CO (Cyclophosphamide- Vincristine) regimen. The average number of cure received was 7 cycles/patient (extremes of 4 and 13 cures) including 3 cures of consolidation after negativation of the βHCG. The evolution was favorable for the majority of patients with complete remission in 85,15% of cases. Some patients had a relapse in 11,11% of cases and progression under chemotherapy in 3,70% of cases for which they benefited from second line chemotherapy, the EMA (Etoposide- Methotrexate-Actinomycin D) – EP (Cisplatin- Etoposide) regimen with a good evolution. No death have been reported.
Conclusion:
The optimal management of these high-risk GTT depends on prompt diagnosis, propers treatment and referral to centers with expertise in the management of such tumors.
The preferred chemotherapy for high-risk GTT remains EMA-CO regimen which is the best chance of tumor eradication with minimum toxicity, maximum cure and preserving the fertility of patients.
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