Deciding about the appropriate chemotherapy regimen for gestational trophoblastic tumours

A retrospective analysis of 75 patients suffering from gestational trophoblastic tumours treated at the Gujarat Cancer Research Institute (GCRI), Amadavad, between 1995 and 1999 has been done. According to the WHO scoring system, 48 percent 21.3 percent and 30.7 percent of patients were of low risk (LR), medium risk (MRR) and high risk (G\HR) groups, respectively. Low risk (LR) patients were treated with methotrexate and folinic acid (MTX-FA) regimen. The medium risk (MR) patients received either MTX-FA or etoposide, methotrexate and actinomycin (EMA) and the high risk (HR) patients received EMA or EMA plus cyclophosphamide and vincristive (EMA-CO). Those with confirmed brain metastasis also received intrathecal methotrexate. All the patients (100 percent) with LR achieved remission with the most commonly used regimen MTX-FA. The MR group of patients also achieved 100 percent remission with MTX-FA,EMA, or EMA-CO regimen. Remission rate in the HR group was 61.1 percent (11/18) with the first line chemotherapy and additional 22.2 percent remission rate (4/18) was achieved with the second line chemotherapy (i.e. cisplatin and etoposide) making the total CR of 83.3 percent. Most commonly used regimen in HR group of patients was EMA-CO (10 as the first and 2 as the second line chemotherapy). Usefulness of EMA regimen in MR and HR groups of patients requires further study.