August 22nd, 2019

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Diagnosis and Treatment of High-Risk Metastatic Gestational Trophoblastic Neoplasia in Hungary: 40 Years of Experience
Authors:  Vilmos Fülöp, M.D., Ph.D., D.Sc., Iván Szigetvári, M.D.,† János Szepesi, M.D., György Végh, M.D., János Demeter, M.D., and Ross S. Berkowitz, M.D.
  OBJECTIVE: To review treatment results of high-risk metastatic gestational trophoblastic neoplasia (GTN) over the last 40 years in Hungary.

STUDY DESIGN: Between January 1, 1977, and December 31, 2016, 197 patients were treated with high-risk metastatic GTN. Primary chemotherapy was selected based upon the patient’s stage of GTN and prognostic score. Surgery was performed mainly to either resect sites of chemotherapy-resistant disease or to treat acute complications.

RESULTS: As a primary therapy, MAC was used in 124 high-risk cases and EMA-CO in 42 high-risk cases; out of those cases, 114 (91.9%) and 33 (78.6%) patients, respectively, achieved complete remission. As compared to the administration of the MAC regimen, during the last 10 years the use of EMA-CO primary combination chemotherapy had favorable outcomes and was significantly increased among our metastatic high-risk patients with more serious GTN (MAC/EMA-CO ratios between 1977–2006: 5.9 [100/17] and between 2007–2016: 0.9 [24/25]; p<0.05). Over the period of 1977–2016 54/197 (27.4%) hysterectomies were performed, while metastases were resected in 37/197 (18.8%) of high-risk patients.

CONCLUSION: Patients with high-risk metastatic GTN should primarily be treated with EMA-CO combination chemotherapy, while surgery still plays a valuable role in the disease management.
Keywords:  anatomical stages, chemotherapy, choriocarcinoma, gestational trophoblastic disease, gestational trophoblastic neoplasia, high-risk metastatic gestational trophoblastic neoplasia, hysterectomy, metastasis surgery, prognostic score
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