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ORIGINAL ARTICLE
Year : 2014  |  Volume : 10  |  Issue : 3  |  Page : 646-650

Evaluation of weekly intramuscular methotrexate in the treatment of low risk gestational trophoblastic neoplasia


1 Department of Gynecologic Oncology, Women Health Research Center, Harvard Medical School, USA
2 Renal Basic Science Laboratory, Brigham and Women's Hospital, Harvard Medical School, USA
3 Department of Oncology Radiotherapy, Mashhad University of Medical Sciences, Ghaem Hospital, Mashhad, Iran
4 Department of Community Medicine, School of Medicine, Ghaem Hospital, General Physician, Mashhad, Iran
5 Department of Gynecologic Oncology, Ghaem Hospital, General Physician, Mashhad, Iran
6 Student of Medical Sciences, Mashhad University of Medical Sciences, Ghaem Hospital, Mashhad, Iran

Correspondence Address:
Azadeh Tabari
Room 520, HIM, 4 Blackfan, Cir, Boston
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.138199

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Background: The gestational trophoblastic neoplasms (GTNs) are rare and potentially life-threatening malignancies. Aims: The aim of this study was to determine the rate of response to weekly intramuscular (IM) methotrexate (MTX) in patients with low-risk GTN (LR-GTN). Settings and Design: The study was designed cross-sectional and prospectively. Patients followed for 1 year. Materials and Methods: From 2006 to 2011, a total of 117 women with LR-GTN were studied. A weekly MTX regimen (50 mg/m 2 with dose escalation to 75 mg/m 2 ) was administered to 87 of patients. A biweekly pulsed intravenous bolus of 1.25 mg/m 2 of actinomycin D was administered in patients resistant to MTX (n = 30) and combination therapy was performed in those who did not respond to aforesaid treatments (n = 8). Statistical Analysis: The data were analyzed using Statistical Package for Social Sciences (SPSS) 11.5 and Chi-square model was applied. Descriptive statistics and compare means (t-test) was used as well. P < 0.05 was statistically significant. Results: All 117 patients with LR-GTN were cured. The primary remission rate was 74.3%, with primary dose of 50 mg/m 2 of MTX and escalation to 75 mg/m 2 . Another patient achieved complete remission with actinomycin and combination chemotherapy. There were significant statistical correlation between remission and World Health Organization (WHO) scoring, International Federation of Gynecology and Obstetrics (FIGO) staging, pretreatment beta-human chorionic gonadotropin (β-hCG) level, and antecedent pregnancy (P < 0.05). Conclusion: We suggest that cases with score ≥6 should be considered high risk. First-line combination chemotherapy is advised in GTN with score ≥6.


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