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gestational trophoblastic neoplasia: Clinical and Therapeutic Profile in Madagascar

Open Journal of Obstetrics and Gynecology 2020年第7期10卷 946-956页

作者： Norosoa Randriamaroson Malala Razakanaivo Ny Ony Andrianandrasana Zo Ambinintsoa Solofonirina Florine Rafaramino Radiotherapy Department University Hospital Joseph Ravoahangy Andrianavalona Antananarivo Madagascar Medical Oncology Department University Hospital Joseph Ravoahangy Andrianavalona Antananarivo Madagascar Faculty of Medicine Antananarivo Madagascar

gestational trophoblastic disease (GTD) develops from abnormal cellular proliferation of trophoblasts following fertilization. This includes complete and partial hydatidiform mole (HM) and gestational trophoblastic neoplasia (GTN). The aim of this study was to report the epidemiological, clinical and therapeutic profile of gestational trophoblastic neoplasia (GTN) over period of ten years in the department of Oncology Radiotherapy at the University Hospital Joseph Ravoahangy Andrianavalona (HJRA) Antananarivo Madagascar. Medical records of women diagnosed with GTD in the department of Oncology Radiotherapy at HJRA from January 1st, 2007 to September 2017 were retrospectively reviewed. Only patients with the FIGO diagnosis GTN were included, while those with the histological diagnosis of hydatidiform mole (HM), also sometimes classified as GTD, were not included in this study. Also excluded were all cases with incomplete or missing data. Twenty four patients were included. Median age of patients at the time of diagnosis was 37 years (range 18 - 60). Most patients developed GTN following molar pregnancy (75%), had disease duration from antecedent pregnancy of less than 6 months (58.20%), and had the pre-treatment hCG level more than 10,000 IU/L (58.27%). At diagnosis, 14 patients (58.33%) had localized disease (M0). Most common metastatic sites at initial diagnosis were the liver and brain (20.8

关键词： Choriocarcinoma gestational trophoblastic Disease gestational trophoblastic neoplasia Madagascar

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Efficacy and Risk Factors Associated to Resistance to Single-Agent Chemotherapy in Low-Risk gestational trophoblastic neoplasia

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Open Journal of Obstetrics and Gynecology 2016年第1期6卷 50-55页

作者： Mamour Gueye Mame Diarra Ndiaye-Gueye Serigne Modou Kane-Gueye Fatou Niass Dia Aissatou Thiam Sr. Elisabeth Diouf Jean Charles Moreau Gynecologic and Obstetric Clinic Aristide Le Dantec Teaching Hospital Cheikh Anta Diop University Dakar Senegal

Objectives: This study aimed to assess efficacy of intramuscular methotrexate 8-day protocol in the treatment of low-risk gestational trophoblastic neoplasia and also identify prognostic factors associated with treatment failure, necessitating second line chemotherapy. Methods: This study was performed at Gynaecologic and Obstetric Clinic of Dakar Teaching Hospital, the reference Centre of gestational trophoblastic Disease in Senegal. At the beginning of 2011, patients were followed according to FIGO’s recommendations. From 2011 to 2014, we diagnosed 88 low-risk gestational trophoblastic neoplasia (GTN) patients (WHO score < 7). Low-risk patients started their treatment with methotrexate (MTX) based on the 8-day protocol consisting of 1 mg/kg MTX in combination with 0.1 mg/kg folinic acid (FA) every other day. Resistance to treatment was the main outcome. We studied the association of different prognostic factors included in the World Health Organisation (WHO) scoring system and resistance to the initial single agent chemotherapy. Results: Eighty-eight patients were diagnosed for GTN during the study period. Average age was 31 years. The antecedent pregnancy was molar in 98.1% of cases. Seventy-four patients underwent remission after single agent-chemotherapy. Resistance rate to single-agent chemotherapy was 15.9% (14 patients). Nine of them achieved remission after second line chemotherapy. WHO score was significantly associated with the risk of resistance to single-agent chemotherapy. Other variables included in the WHO as age, antecedent pregnancy, pre-treatment hCG, tumour size and FIGO stage were not significantly associated with resistance. We report five fatal cases. Conclusion: The 8-day protocol consisting of 1 mg/kg MTX in combination with 0.1 mg/kg folinic acid (FA) every other day is effective for women with LRGTN. The only significant prognostic factor for failure is pretreatment WHO score. We highly recommend the use of this protocol particularly in de

关键词： gestational trophoblastic neoplasia Chemotherapy International Federation of Gynecology and Obstetrics Resistance

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