EMA-CO As Primary Treatment For Ultra High-Risk Gestational Trophoblastic Neoplasia

BackgroundGestational trophoblastic neoplasia is a kind of cancer which has the best prognosis up to now.For high risk GTN,The cure rate is estimated to be 80%-90%.EMA-CO regimen is recommended for primary treatment by many foreign authorities。FIGO Cancer report 2015 proposed the concept of ultra high risk gestational trophoblastic neoplasia,which refers to a subgroup with a score greater than or equal to 12 as well as patients with liver,brain,or extensive metastases did poorly when treated with first-line multiple agent chemotherapy.For ultra high risk gestational trophoblastic neoplasia,EP-EMA may get a better curative effect for primary treatment。However,EP-EMA is limited because of its severe bone marrow suppression and hepatotoxicity which may cause dose reduction and the interruption of chemotherapy。ObjectiveTo evaluate EMA-CO regimen as primary treatment for ultra high risk gestational trophoblastic neoplasia.MethodsDate on 22 eligible cases with GTN in Women Hospital affiliated Zhejiang University from January 2001 to December 2015。All of the cases were reviewed and the relations of different factors and outcomes of chemotherapy were evaluated.Results:Date on 22 cases with ultra high risk gestational trophoblastic neoplasia.Among all of the cases,the FIGO prognostic risk factor scores were≥7,average 13.0,17 cases were scored ≥12,5 cases were scored<12;7 patients got metastasis of liver or brain,15 patients not.22 patients received 150 courses of EMA-CO regimen,14 patients achieved complete remission,8 patients showed drug-resistant.The complete remission of EMA-CO regimen was 63.6%The major toxicities of EMA-CO regimen including bonemarrow suppression,abnormal liver function,digestive tract side effect and alopecic.Few parts of patients showed fever,peripheral neuritis,oral ulcer.8 patients(20 courses in total)accepted EMA regimen instead of EMA-CO regimen because of severe toxic and side effects.All the patients without secondary tumor.Conclusion:EMA-CO is an effective regimen with manageable toxicity for patients with ultra high risk GTN as primary treatment.