Clinical Analysis Of 7 Cases With Ultra-high Gestational Trophoblastic Neoplasms

Background:Gestational trophoblastic neoplasms(GTN)is a rare type of gynecologic malignant tumor.The main therapeutic strategies is systemic chemotherapy.According to the prognosis score of the International Union of Obstetrics and Gynecology(FIGO),the patients with less than 7 points are low risk,and those with greater than or equal to 7 are high risk.The overall survival(OS)rate almost approaches 100%in low-risk patients,whereas high-risk patients can achieve a overall survival rate of 80-90%.Patients with the FIGO prognosis score?12 points or those with liver,brain metastases,or extensive metastases were defined as ultra high-risk patients.Treatment of ultra high-risk patients has been poor,and mortality rate has been high.The main reasons include widespread chemotherapy-resistant disease,respiratory failure due to progressive disease in the lungs or hemorrhage from brain and liver metastases.Objective:The clinical data of primary treated ultra-high risk gestational trophoblastic neoplasms patients were retrospectively analyzed,and their clinical characteristics,treatment regimens,toxicity and prognosis were discussed.Materials and methods:Through inquiring the case management system and retrieving GTN patients receiving treatment in the First Affiliated Hospital of Zhejiang University from March 2014 to March 2018,Clinical data of 7 cases with ultra-high gestational trophoblastic neoplasms were retrospectively analyzed.Results:The primary chemotherapy regimen for 7 patients with ultra-high risk GTN was EMA-CO regimen.Complete remission was achieved in 4 cases,and 3 cases were currently in the process of treatment.5 patients were treated with surgical treatment and pathologic tests all showed Choriocarcinoma.Alopecia,nausea and vomiting and other gastrointestinal reactions and IV grade myelosuppression were appeared in all 7 patients.4 cases with ultra-high risk GTN patients who had finished the treatment insist on regular followed up,range 5 months to 1 years.No recurrence was found.Conclusions:1.Due to the good therapeutic effect and tolerable toxicity,the EMA-CO regimen can be the primary chemotherapy regimen for ultra-high gestational trophoblastic neoplasms.2.The therapeutic strategies for ultra high-risk GTN patients should be treated with combined chemotherapy,supplemented by surgery or interventional therapy.