High risk malignant gestational trophoblastic disease: experience with triple chemotherapy (MAC) in Third World circumstances.

Fifty-seven patients with malignant gestational trophoblastic disease (GTD) were treated by the Gynecologic Oncology Unit of the Tygerberg Hospital, Parowvallei, RSA, between 1977 and 1986. Treatment was primarily with triple chemotherapy (MAC) followed by citrovorum factor. The total remission rate in the 23 patients with high risk malignant GTD was 78.3% but in the 16 patients categorized as poor prognosis metastatic disease the remission rate dropped to 68.8%. The third world background in the majority of our patients, the poor general health, and the language barrier indirectly influenced the management of these patients. Psychological problems were evident in 60.9% of our patients. This often resulted in poor patient compliance which adversely influenced the outcome of the disease.