A 30-year experience in using oral methotrexate as initial treatment for gestational trophoblastic neoplasia regardless of risk group

Figures & data

Table I. Chemotherapy schedules used at Aarhus University Hospital for the treatment of postmolar GTN since 1981.

Chemotherapy schedule
First-line: (MTX)	Per oral methotrexate (MTX) 2.5 mg administered 4 times a day for 5 days with oral calcium folinat (1 ml × 4 daily). Schedule repeated every 4 weeks (alternatively every 3 weeks).
Second-line: (MTX+ Act-D)	MTX regime (1. line) + dactinomycin (Act-D) 0.5 mg i.v. for 5 days Schedule repeated every 4 weeks (alternatively every 3 weeks).
Third-line: (BEP)	Bleomycin 30,000 IU i.v. day 2, 9, and 16, etoposide 100 mg/m^2 i.v. day 1–5 (since 2010: 165 mg/m^2 i.v. day 1–3) and cisplatin 20 mg/m^2 i.v. day 1–5 (since 2010: 50 mg/m^2 i.v. day 1–2). Schedule repeated every 3 weeks.

i.v., intravenous.

Table II. Clinical characteristics of 71 patients treated for postmolar gestational trophoblastic neoplasia at Aarhus University Hospital in the period 1981–2011 distributed in three groups according to the line of chemotherapy on which they achieved complete remission. The number total of chemotherapy courses always include the course given for consolidation.

	First-line	Second-line	Third-line	All
All patients	35 (49%)	27 (38%)	9 (13%)	71 (100%)
Low-risk	35	23	6	64 (90%)
High-risk	0	4	3	7 (10%)
FIGO score^a	1 (0–6)	4 (1–10)	6 (1–14)	3 (0–14)
FIGO-stage, I/II/III/IV^b	26/1/8/0	18/0/9/0	5/0/3/1	49/1/20/1
Number of courses^a	3 (1–10)	6 (3–8)	8 (5–9)	5 (1–10)
Treatment time/days^a	60 (5–253)	118 (53–234)	162 (107–227)	110 (5–253)
Age^a	28 (18–54)	32 (15–56)	30 (20–34)	27 (15–56)
hCG^c before chemotherapy^a	1186 (11–130 000)	21000 (40–200 000)	65000 (3200–670 000)	5500 (11–670 000)

^aMedian (range); ^bNumber of patients with the stages indicated; ^cSerum human choriogonadotropin.

Figure 1. Overall treatment time in 71 patients with postmolar gestational trophoblastic neoplasia plotted as a function of serum human choriogonadotropin (hCG) measured just before start of chemotherapy by use of LOG-linear regression (R² = 0.39; p < 0.001). Open circles indicate low-risk (N = 64) and solid circles (N = 7) high-risk patients according to FIGO scoring system.

Figure 2. The median serum human choriogonadotropin (hCG) level before start of each course of chemotherapy for the 71 patients with postmolar gestational trophoblastic neoplasia divided into three groups according to the line of chemotherapy, by which they obtained complete remission. The total number of chemotherapy courses was median of three, six and eight for final remission on first- (black squares), second- (gray circles) and third-line chemotherapy (open circles), respectively.