Persistent gestational trophoblastic disease: Report of 20 cases and literature review
Jed Diari, Amel Achour, Mohamed Wahab Abdallah, Dalenda Chelli and Fethia Boudaya
Paris Hospitals, France
: J Neurosci Clin Res
Abstract
Objective: This retrospective study aimed at discussing epidemioclinical criteria and therapeutic results of persistent gestational trophoblastic disease (PGTD) throughout a series of 20 patients treated between 2008 and 2015.
Patients and methods: We reviewed the epidemioclinical records of all the patients. After aspiration, pretherapeutic work-up, and hebdomadary dosage of plasmatic HCG, patients were divided into three prognostic groups according to the Gustave- Roussy Institute (IGR) classification (Hydatidiform mole, Low-risk tumors, and High-risk tumors). They were treated with different chemotherapy protocols: monodrug Methotrexate (MTX) therapy, AE protocol (Actinomycin and Etoposid), and APE protocol (Actinomycin, Etoposid, and Cisplatinum) adapted to each group.
Results: The mean age was 32 years (range: 20 to 49). Metrorrhagia and pelvic pain were the most frequent symptoms. There were 20 cases of PGTD (mole retention: three cases, invasive moles: 13 cases and choriocarcinoma: 4 cases). All the evaluable patients (18 patients) were cured with the first-line chemotherapy or after salvage chemotherapy in patients with considerable risk for the disease who showed a resistance to monodrug Methotrexate therapy. We recorded one toxic death with APE protocol.
Conclusions: The epidemioclinical criteria did not have any particularity. We confirmed the effectiveness of chemotherapy in PTGD. However, if we consider efficacy/toxicity ratio and the recent data of the WHO classification modified by FIGO, therapeutic deescalate may be justified at least in patients with good observance.
Biography
Jed Diari is a MD/PhD in Gynecology Obstetrics and Reproductive medicine.He has graduated in fetal medicine and Oncology from Paris Descartes UniversityHe has graduated in gynecological surgery from Harvard medical schoolwith an European Diploma in Laparoscopic Surgery. He has graduated in colposcopy and cervicovaginal diseases from the University of Angers.
E-mail: drjad@yahoo.fr
