JRI 

Zohreh Yousefi Corresponding Author
- Department of Obs. & Gyn., Ghaem Hospital, Faculty of Medicine, Mashad University of Medical Sciences and Health Services, Mashad, Iran
Sedigheh Ayaty
- Department of Obs. & Gyn., Ghaem Hospital, Faculty of Medicine, Mashad University of Medical Sciences and Health Services, Mashad, Iran

Received: 10/1/2006 Accepted: 10/1/2006 - Publisher : Avicenna Research Institute

Related Articles

 

Other Format

 


Abstract

Introduction: The essentials of gestational trophoblastic disease (GTD) treatment are evacuation of the uterus followed by chemotherapy. Methotrexate, an antagonist of folinic acid and an antimetabolite agent, has an important role in the treatment of patients with gestational trophoblastic disease. The efficacy of single agent chemotherapy with methotrexate in low and medium risk GTD is well-established and nume-rous studies for lowering its toxicity and fewer numbers of expected visits and consequently lower time and money expenditures are on rise. This medication has produced excellent remission rates with acceptable toxicity, cost-effectiveness and better compliance by patients. The aim of this study was to compare two methods of weekly single-dose intramuscular and 8-day intravenous injections of methotrexate, in low and medium risk GTD patients who required single agent chemotherapy.Materials & Methods: This was a clinical trial study conducted for three years (2002-5) in the Gynecolo-gic Oncology Department of Ghaem Hospital in Mashad. All patients with low and medium risk GTD who required single agent chemotherapy were assigned into two groups. The first group consisted of 33 patients who received IV injections of methotrexate 1 mg/m2 of body surface area and folinic acid 0.1 mg/m2 every other day for a total of 8 days. The second group consisted of 14 patients that received weekly single-dose IM injections of methotrexate 50 mg/m2. These two groups were matched for age, number of pregnancies, blood groups, histological characteristics and the interval between end of the antecedent pregnancy and start of chemotherapy. The results were analyzed by SPSS software. For statistical calculations t-test and χ2 were used and a confidence internal of 95% and a p-value of 0.05, as the significant value, were regarded for the study.Results: The mean age of the first group was 25.387.33 years and 25.77.52 for the second group. Response rates fewer than four courses of chemotherapy in the first group was 45.5% and in the second group was 28.5% (p=0.018). The results showed that 9.9% of the patients in the first group and 42.1% of those in the second group needed nearly a 1.5-time increase in the dose of the medication (p=0.001). Requiring a change to the second line of therapy from methotrexate to actinomycin D was 6.6% in the first and 7.1% in the second group (p=0.715). Combination chemotherapy with EMA/CO (Etoposide, methot-rexate, actinomycin D, cyclophosphamide and vincristine) regimen were needed by 9.9% of the patients in the first and 14.2% in the second group (p=0.656). Eventually, both groups achieved complete remission with no recurrence of the disease during the follow-up period. Conclusion: The weekly single-dose intramuscular injection of methotrexate is an effective, low toxic, inexpensive and accessible method that can be performed in every center for low and medium risk GTD patients that need single agent chemotherapy as compared with 8-day intravenous injections.


Keywords: Gestational trophoblastic disease, Methotrexate, Actinomycin D, EMA-CO, Chemotherapy, HCG, Hydatid mole


To cite this article:


References

  1. Khanlian SA, Smith HO, Cole LA. Persistent low levels of human chorionic gonadotropin: A premalig-nant gestational trophoblastic disease. Am J Obstet Gynecol. 2003;188(5):1254-9   [PubMed]
  2. Rock JA. THompsen SD. Telinde‘s Operative Gyneco-log. 8th Edition. Lippincott company. 1997;pp:1607-32
  3. Wong LC, Ngan HY, Cheng DK, Ng TY. Methotrexate infusion in low-risk gestational trophoblastic disease. Am J Obstet Gynecol. 2000;183(6):1579-82   [PubMed]
  4. Homesley HD. Single agent therapy for nonmetastatic and low-risk gestational trophoblastic disease.J Reprod Med. 1998;43(1):69-74   [PubMed]
  5. Homesley HD, Blessing JA, Rettenmaier M, Capizzi RL, Major FJ, Twiggs LB. Weekly intramuscular methotrexate for nonmetastatic gestational trophoblas-tic disease. Obstet Gynecol. 1988;72(3 Pt 1):413-8. Review   [PubMed]
  6. Gleeson NC, Finan MA, Fiorica JV, Robert WS, Hoffman MS, Wilson J. Nonmetastatic gestational tro-phoblastic disease. Weekly methotrexate compared with 8-day methotrexate-folinic acid. Eur J Gynaecol Oncol. 1993;14(6):461-5   [PubMed]
  7. Garrett AP, Garner EO, Goldstein DP, Berkowitz RS. Methotrexate infusion and folinic acid as primary therapy for nonmetastatic and low-risk metastatic gestational trophoblastic tumors. 15 years of experi-ence. Reprod Med. 2002;47(5):355-62   [PubMed]
  8. Hilgers RD, Standefer JC, Rutledge JM, Ampuero F. Trophoblastic cell sensitivity to 8-day chemotherapy in nonmetastatic gestational trophoblastic neoplasia. Gynecol Oncol. 1984;17(3):386-93   [PubMed]
  9. CHauhan S, Diamond MP, Johns DA. A case of molar ectipic pregnancy. Fertil Steril. 2004;81:1140   [PubMed]
  10. Goldstein DP, Goldstein PR, Bottomley P, Osatha-nondh R, Marean AR. Methotrexate with citrovorum factor rescue for nonmetastatic gestational tropho-blastic neoplasms. Obstet Gynecol. 1976;48(3):321-3   [PubMed]
  11. Gilani MM, Yarandi F, Eftekhar Z, Hanjani P. Com-parison of pulse methotrexate and pulse dactinomycin in the treatment of low-risk gestational trophoblastic neoplasia. Aust N Z J Obstet Gynaecol. 2005;45(2):161-4   [PubMed]
  12. Ghaemmaghamia F, Ashraf Ganjooie A. Gestational trophoblastic neoplasia. Asia pacific J Clin Oncol. 2006;2:9-21
  13. Lu WG, Ding ZM, Xie X, Ye DF, Chen HZ, Feng SW. Single methotrexate chemotherapy for low-risk gestational trophoblastic tumor. Zhongguo Yi Xue Ke Xue Bao. 2003;25(4):414-7   [PubMed]
  14. Wong LC, Ngan HY, Cheng DK, Ng TY. Metho-trexate infusion in low-risk gestational trophoblastic disease. Am J Obstet Gynecol. 2000;183(6):1579-82   [PubMed]
  15. Smith EB, Weed JC Jr, Tyrey L, Hammond CB. Treatment of nonmetastatic gestational trophoblastic disease: results of methotrexate alone versus metho-trexate-folinic acid. Am J Obstet Gynecol. 1982;144 (1):88-92   [PubMed]
  16. Soper JT, Clarke-Pearson DL, Berchuck A, Rodriguez G, Hammond CB. 5-day Methotrexate for women with metastatic gestational trophoblastic. Gynecol Oncol. 1994;54(1):76-9   [PubMed]
  17. Matsui H, Suzuka K, Yamazawa K, Tanaka N, Mitsu-hashi A, Seki K, et al. Relapse rate of patients with low-risk gestational trophoblastic tumor initially treat-ed with single-agent chemotherapy. Gynecol Oncol. 2005;96(3):616-20   [PubMed]
  18. McNeish IA, Strickland S, Holden L, Rustin GJ, Fos-kett M, Seckl MJ, et al. Low-risk persistent gestational trophoblastic disease: outcome after initial treatment with low-dose methotrexate and folinic acid from 1992 to 2000. J Clin Oncol. 2002;20(7):1838-44   [PubMed]
  19. Kohorn EI. Negotiating a staging and risk factor scor-ing system for gestational trophoblastic neoplasia. A progress report J. Reprod Med. 2002;47:445   [PubMed]
  20. Moodley M, Tunkyi K, Moodley J. Gestational tro-phoblastic syndrome: an audit of 112 patients. A south African experience. Int J Gynecol Cancer. 2003;13(2): 234-9   [PubMed]
  21. Lurain JR. Treatment of gestational trophoblastic tumors. Curr Treat Options Oncol. 2002;3(2):113-24   [PubMed]
  22. Hoffman MS, Fiorica JV, Gleeson NC, Roberts WS, Cavanagh D. A single institution experience with weekly intramuscular methotrexate for nonmetastatic gestational trophoblastic disease. Gynecol Oncol.1999; 60(2):262-4   [PubMed]
  23. Homesley HD, Blessing JA, Schlaerth J, Rettenmaier M, Major FJ. Rapid escalation of weekly intramuscular methotrexate for nonmetastatic gestational trophoblas-tic disease: a Gynecologic Oncology Group study. Gynecol Oncol. 1990;39(3):305-8   [PubMed]
  24. Alici S, Eralp Y, Saip P, Argon A, Basaran M, Topuz E, et al. Clinical characteristics of gestational tropho-blastic disease at a single institute. Tohoku J Exp Med. 2002;197(2):95-100   [PubMed]

COPE
SID
NLM
AJMB
IJBMLE
IJBMLE

Home | About Us | Current Issue | Past Issues | Submit a Manuscript | Instructions for Authors | Subscribe | Search | Contact Us

"Journal of Reproduction & Infertility" is owned, published, and managed by Avicenna Research Institute .
Creative Commons License

This work is licensed under a Creative Commons Attribution –NonCommercial 4.0 International License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.

Journal of Reproductoin and Infertility (JRI) is a member of COMMITTEE ON PUBLICATION ETHICS . Verify here .

©2024 - eISSN : 2251-676X, ISSN : 2228-5482, For any comments and questions please contact us.