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Indian Journal of Medical and Paediatric Oncology
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Year : 2020  |  Volume : 41  |  Issue : 3  |  Page : 345-350

Management of “Ultra-High Risk” gestational trophoblastic neoplasia at a tertiary center in India

1 Department of Gynecologic Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
2 Department of Medical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India

Correspondence Address:
Dr. Ruchi Arora
Department of Gynecologic Oncology, Gujarat Cancer and Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijmpo.ijmpo_235_18

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Aims: The aim of this study is to identify clinicopathological features associated with increased morbidity and mortality in cases of “ultra-high risk” gestational trophoblastic neoplasia (GTN) and to compare initial low-dose etoposide-cisplatin (EP) induction chemotherapy with respect to etoposide methotrexate adriamycin cyclophosphamide vincristine (EMACO) regimen. Settings and Design: This was a retrospective study of patients of high-risk GTN from January 2012 to December 2016 with criteria mentioned as “ultra-high-risk group;” pathological or suspected diagnosis of choriocarcinoma, multiple (>20) pulmonary metastases or associated with hemoptysis, brain metastases, large-volume liver metastases, profuse vaginal bleeding, human chorionic gonadotropin >1000,000 IU/L, interval since the last antecedent pregnancy of >2.8 years. Subjects and Methods: Comparison between the two groups of chemotherapy regimens and the median number of chemotherapy courses required to achieve complete remission was done Statistical Analysis Used: Data were analyzed using the SPSS software version 18 and Fisher's exact test with P value statistically significant at the level of 0.05. Results: Thirty-seven cases were high-risk GTN and 24 were “ultra-high risk.” The higher percentage of patients underwent remission of disease following low-dose induction chemotherapy as compared to primary EMACO therapy, 71.4% versus 58.8%. No resistance to second-line chemotherapy was noted, and no surgical intervention was required in the patients receiving low-dose induction chemotherapy before EMACO. Conclusions: We noted a decrease in the proportion of patients developing resistance to primary chemotherapy and lesser adverse effects in those receiving initial low-dose induction EP chemotherapy.

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