Clinical Profiles of Gestational Trophoblastic Tumor with High-Risk Site Metastases

Lee, Hyo Pyo; Kim, Jae Weon; Koh, Chang Won; Park, Noh Hyun; Song, Yong Sang; Kang, Soon Beom

Abstract

Gestational trophoblastic tumor(GTT) is one of the most curable malignancies, but metastatic GTT involving high-risk sites(brain, liver, kidney etc.) have been recognized as an adverse prognostic factor. Most centers have treated these patients using multiagent chemotherapy with radiotherapy and/or surgery, but there is still no consensus concerning the optimal treatment strategies. We present our clinical experience in GTT patients with high-risk sites metastases with review of the literatures. We retrospectively reviewed the records of GTT patients treated at the Seoul National University Hospital between 1980 and 1994, and identified 22 GTT patients with high-risk site metastases and analysed prognostic factors which influence the survival. The patients ranged in age from 19 to 57 years(mean, 32 years). All 22 patients had concurrent lung involvement and 15 patients with brain metastases presented with neurologic symptoms. There was 9 cases with metastases to brain only, 5 with metastases to liver only, 3 to metastases to brain and liver, and 5 cases with metastases to multiple sites respectively, All Patients received chemotherapy with MAC(methotrexate, actinomycin D, chlorambucil) or etopodside-based regimens, A radiotherapy to the whole brain was given to patients with brain metastases, and splenic artery embolization was done to control the bleeding from the spleen metastasis in on case. With the use of multimodal therapy, 66.7%(6/9) of patients with brain metastases only, and 60%(3/5) of patients with hepatic metastases only achieved one year survival. Overall l year survival rate was 54%. Patients with high-risk sites metastases did not exhibit any statistically significant relationship between known prognostic factors and survival. Unitl now, combination chemotherapy with adjuvant therapy is the standard treatment approach in GTT patients with high-risk site metastases. A search for more effective treatment modality in this group of patients should be continued.