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  • Title: Management of low-risk gestational trophoblastic neoplasia in indigent women.
    Author: Schorge JO, Lea JS, Farrar DF, King MR, Coleman RL, Miller DS.
    Journal: J Reprod Med; 2003 Oct; 48(10):780-4. PubMed ID: 14628732.
    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/m2, intravenous bolus, followed by a 12-hour infusion, 200 mg/m2 (regimen 1); (2) methotrexate, 0.4 mg/kg/m2 intramuscularly for 5 consecutive days on alternating weeks (regimen 2); or (3) methotrexate, 30-50 mg/m2 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 1 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.
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