Evaluation of the Results of Chemotherapy in High Risk Gestational Trophoblastic Tumors with Multidrug EMA-CO Regimen + Granulocyte-Colony Stimulating Factor (G-CSF) Support
Journal Title: International Journal of Contemporary Medical Research - Year 2018, Vol 5, Issue 1
Abstract
Introduction: Among the gynecological malignancies the tumors arising from abnormal fertilization are the GTT. They are of five distinct clinicopathological characteristics, most of them are chemosensitive and curable though some of them metastasize distantly also. EMA-CO regimen provides high remission rate and prolongs survival even in high risk GTT patients, with leucopenia as common side effect. The aim of this study was to complete the treatment within the scheduled time and achieve cure. Material and methods: This is a prospective study of 18 women of high risk gestational trophoblastic tumors evaluated over a period of 4.5 years from February 2008 to August 2012. Only the patients of high risk category were included in this study. They were evaluated for age, duration of amenorrhea, number of deliveries, abortions, the antecedent pregnancy, evacuation for vesicular mole and previous chemotherapy received. All women were put on EMA-CO regimen (EMA+CO = Etoposide, Methotrexate, Actinomycin+ Cyclophophamide and Vincristine). G-CSF 300μ SC was given on D1and D2 to prevent any delay in schedule due to leucopenia. Intrathecal methotrexate was given to patients suspected of brain metastasis and as prophylaxis in women having pulmonary metastasis. Results: Of the 18 patients treated, 16(88.9%) achieved remission with the EMA-CO regimen. None of the chemotherapy cycles were delayed due to leucopenia, which is a major limiting side effect in earlier studies. Other toxicities of chemotherapy were evaluated. Conclusion: In the present study a complete remission and 5 year survival of 89% has been achieved, which is comparable to the previous studies. The response of the treatment in the GTT patients in this region of the world having different demographic features is similar to those of the other parts of the world. Prophylactic use of G-CSF with EMA-CO regimen in treatment of high risk GTT patients is advocated.
Authors and Affiliations
Ravi Byahut, Mithilesh Kumar
Keywords
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