Gestational trophoblastic disease: treatment results at the Brewer Trophoblastic Disease Center.

Three hundred fifty-nine patients with gestational trophoblastic disease (choriocarcinoma and invasive mole) received complete treatment at the Brewer Trophoblastic Disease Center of Northwestern University Medical School from 1962 through 1978. Data were gathered as of December 31, 1978, to permit a minimum follow-up of 2 years. An overall remission rate of 92% was achieved: 100% (185/185) for nonmetastatic disease and 83% (144/174) for metastatic disease. All 200 patients with invasive mole and 129 of 159 patients (81%) with choriocarcinoma were cured. Chemotherapy was the main form of treatment, with adjuvant surgery and radiation therapy being used in selected patients. Five factors were determined to significantly influence response to treatment in patients with metastatic disease: 1) clinicopathologic diagnosis of choriocarcinoma versus invasive mole (71 versus 100%, P much less than .0005); 2) pretreatment human chorionic gonadotropin titer greater than 100,000 IU/liter and time greater than 4 months from pregnancy event to treatment (62 versus 93%, P much less than .0005); 3) metastases to sites other than lung and/or vagina (37 versus 92%, P much less than .0005); 4) antecedent term gestation compared with hydatidiform mole, abortion, and ectopic pregnancy (56 versus 79%, P less than .02); and 5) prior unsuccessful chemotherapy compared with no previous treatment (48 versus 83%, P much less than .0005). The value of secondary chemotherapy and adjuvant irradiation was evaluated. Relapse from remission was also studied.