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

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/m² with dose escalation to 75 mg/m²) was administered to 87 of patients. A biweekly pulsed intravenous bolus of 1.25 mg/m² 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/m² of MTX and escalation to 75 mg/m². 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.