Outcomes of Non-Metastatic Gestational Trophoblastic Neoplasia: Twelve Year Experience from a Northern Thailand Tertiary Care Center

Gestational trophoblastic neoplasia (GTN) is the malignant form of gestational trophoblastic disease. Innon-metastatic GTN, the outcomes of treatment are impressive with methotrexate (MTX) or actinomycin D.We retrospectively reviewed the outcomes of non-metastatic GTN treated at our center from January, 1999 toDecember, 2013. One hundred and nine patients were recruited to the study. The median age was 33.1 years andover 90% were referral cases. Abnormal vaginal symptoms developed in 37.6% while 56.4% were asymptomatic.The most common antecedent pregnancy was a complete mole (92.7%) with the median interval time fromantecedent pregnancy to GTN development being 2.0 months. The median pretreatment B-hCG was 5,624 mIu/ml. The most common first line treatment was methotrexate (MTX) and folinic acid (91.7%) followed by weeklyMTX (4.6%), etoposide+ MTX+actinomycin D (EMA) (2.8%), and actinomycin D (0.9%), with the mediannumber of cycles at 5.0. The positive response to first line chemotherapy was 73.8%. The patients were givensubsequent chemotherapeutic regimens after resistance to the first line therapy and showed a final remissionrate of 89.9%.The significant factor that was frequently found in patients who were non-responders to the firstline treatment was a hysterectomy procedure. Two patients developed lung metastasis and brain metastasis atone and four years after the first treatment, respectively. In conclusion, the outcomes of non-metastatic GTNwere excellent. However, the patients need long term follow up due to the possibility of developing multiple organmetastases.