Management of Low-Risk Gestational Trophoblastic Neoplasia in Indigent Women

John O. Schorge, Jayanthi S. Lea, Diana F. Farrar, Melanie R. King, Robert L. Coleman, David S. Miller

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

OBJECTIVE: To identify the most effective dosing regimen for indigent patients with low-risk gestational trophoblastic neoplasia (GTN) at high risk of noncompliance. STUDY DESIGN: All women primarily treated for GTN at our public hospital between November 1990 and November 2001 were prospectively entered into a database. Patients were treated with either (1) methotrexate, 100 mg/m 2, intravenous bolus, followed by a 12-hour infusion, 200 mg/m 2 (regimen 1); (2) methotrexate, 0.4 mg/kg/m 2 intramuscularly for 5 consecutive days on alternating weeks (regimen 2); or (3) methotrexate, 30-50 mg/m 2 intramuscularly weekly (regimen 3). Medical records were reviewed to obtain clinical data, and statistical analysis was performed. RESULTS: Thirty-two women were treated for low-risk GTN. The median age at diagnosis was 22 years (range, 15-40). Patients receiving regimen 1 (5/5, 100%) and 2 (19/20, 95%) were more likely to achieve complete remission without switching to dactinomycin or combination chemotherapy than those receiving regimen 3 (3/7, 43%; P<.001). Regimen I required fewer median treatment cycles (1.0, P=.04) than regimens 2 (6.5 cycles) and 3 (8.0 cycles). Seventeen (52%) patients were noncompliant with the chemotherapy protocol and/ or posttreatment surveillance. CONCLUSION: A 1-day methotrexate infusion is highly effective for treating indigent women with low-risk GTN.

Original languageEnglish (US)
Pages (from-to)780-784
Number of pages5
JournalJournal of Reproductive Medicine for the Obstetrician and Gynecologist
Volume48
Issue number10
StatePublished - Oct 1 2003

Keywords

  • Indigent care
  • Methotrexate
  • Trophoblastic neoplasms

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

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