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Gestational Trophoblastic neoplasia: San Gerardo Hospital Monza

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Title: Gestational Trophoblastic neoplasia: San Gerardo Hospital Monza


1
Gestational Trophoblastic neoplasiaSan Gerardo
HospitalMonza
  • Dott.ssa Cristina Bonazzi
  • Caravaggio, 15-17 Maggio 2008

2
GTN MONZA AIMS
  • To present an italian experience of consecutive
    cases examinated with uniform diagnostic and
    therapeutic criteria.
  • To underline patients features
  • To evaluate outcomes - response
  • - survival
  • - fertility
  • - long term
    effects

3
GTN MONZA
  • From Dicember 1981 to Dicember 2007 we observed
    208 patients, most of them referred from other
    centers.
  • We used Charing Cross Hospital criteria to manage
    Hydatidiform Mole and Bagshawes score to stage
    all patients
  • Our patients were divided into low, medium and
    high risk
  • Biomolecular methods werent available to
    identify antecedent pregnancy so we used
    anamnestic criteria

4
Patients score
Age - range 16-54 - median 41
5
Chemotherapy
  • Low Risk MTX-FA
  • Medium Risk - sequential therapy
  • - ACT-D
  • - VP 16
  • - EMA-CO
  • High Risk EMA-CO

6
Symptoms on admission
  • 27 asymptomatic
  • 83 vaginal bleeding (8 transfusions)
  • 7 dyspnoea/chest pain
  • 5 acute abdomen
  • 4 haemoftoe/haemoptysis
  • 4 pelvic pain
  • 1 headache/visual disturbance
  • 1 hematuria

7
Antecedent pregnancy
8
GTN MONZA
  • The antecedent pregnancy was an Hydatidiform
    Mole in the 86 in Low Risk, 46 in Medium Risk
    and 35 in High Risk.
  • Antecedent term pregnancy was present only in 3
    patients in Low Risk instead of 37 in High.
  • In five cases 5 GTN arised from ectopic
    pregnancy.
  • In five cases GTN followed termination.

9
Interval from index pregnancy
10
Pre-treatment serum Beta HCG
  • Low risk median 34.949 mU/ml
  • (range 0 185.529)
  • Beta gt 20.000 mU/ml
  • - 26 patients
  • - 18/26 (69)
    resistances
  • High risk median 227.781 mU/ml
  • (range 1896.650.000)

11
Metastatic disease
17 isolated lung metastasis and 2 vaginal
metastasis
12
Metastatic sites74/208 (36)
13
Hystologic diagnosis of Choriocarcinoma
14
Low Risk
  • 79/129 patients (61) achieved a complete
    response to MTX-FA
  • 50/129 patients (39) developed MTX resistance
  • The diagnosis of resistance was based on serum
    HCG levels rise in 15
  • patients and plateau in 35 patients.
  • What are the possible factors related to
    methotrexare resistance?

15
Low Risk129 Pts
16
Low Risk results
  • - 5 patients relapsed, 2 of them belonged MTX
    resistance group.
  • All patients achived a complete remission after
    polichemotherapy
  • Overall survival was 97
  • - 2 patients died for other cancer (lung and
    breast)
  • - 1 patient for trophoblastic disease

17
High Risk results
  • Overall survival was 80
  • 8 patients died
  • 7 patients (17) disease related death
  • - 5 for progression
  • - 1 for
    toxicity during first course of therapy
  • - 1 for
    leukemia (14/12 after completion of
    treatment)
  • 1 patient colon cancer without
    evidence of Trophoblatic disease
  • What are the possible factors affecting survival?

18
High Risk40 Pts
1 leukaemia
19
High Risk40 Pts
  • The highest the score, the highest the mortality
  • In the High Risk group 7 patients died for
    Trophoblastic disease
  • Number of Deaths
  • - SCORE 10-13 0/13
  • 14-20
    2/15
  • gt 20
    5/11

  • 7/39

20
Fertility208 Pts
  • Surgical treatment
  • Non conservative 56 patients
  • Conservative 152 patients
  • - 127 Term pregnancies in 84 pts
  • - 34 Miscarriages in 26 pts
  • - 2 Hydatidiform moles
  • - 6 Terminations

21
Second tumors
  • 1 VP16 / 1 EMA-CO
  • ( ) Death for cancer

22
Conclusion
  • GTN challenging disease
  • Progress made in diagnosis and treatment of the
    disease
  • Importance of Referral Centers
  • Importance of a Registration system from a
    clinical and research point
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