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Treatment of relapses of gestational trophoblastic neoplasias
Author(s) -
L. A. Meshcheryakova,
Л. А. Мещерякова,
A. S. Zharova,
A. S. Zharova,
А Ф Масленников,
А Ф Масленников,
В. В. Кузнецов,
В. В. Кузнецов,
М. А. Чекалова,
М. А. Чекалова,
И. Г. Комаров,
И. Г. Комаров,
I. Yu. Davydova,
И. Ю. Давыдова,
G. V. Molchanov,
G. V. Molchanov,
N. M. Gigolaeva,
N. M. Gigolaeva,
A. A. Meshcheryakov,
А. А. Мещеряков
Publication year - 2020
Publication title -
rossijskij onkologičeskij žurnal
Language(s) - English
Resource type - Journals
eISSN - 2412-9119
pISSN - 1028-9984
DOI - 10.18821/1028-9984-2020-25-1-9-16
Subject(s) - medicine , chemotherapy , surgery , retrospective cohort study , hysterectomy
The purpose of the study: to present an experience of the N. N. Blokhin Russian Cancer Research Center in the treatment of relapses of gestational trophoblastic neoplasias (GTN). Materials and methods. We performed a retrospective analysis of medical case histories at the N. N. Blokhin Russian Cancer Research Center from 1996 until 2019. 545 patients with GTN were treated. Relapses occurred in 25 (4.6%) patients: 8 (2.1%) patients with low risk of resistance (6 (75%) early relapses and 2 (25%) late relapses) and 17 (10%) patients with high risk of resistance (11 (65%) early relapses and 6 (35%) late relapses). Treatment of relapses was done by standard chemotherapy regimens (Dactinomycin 500mcg in days 15, EMA-CO, EMA-EP). Different surgical interventions and radiosurgery were used in some cases additionally. Results. Out of 6 patients with early relapses of low-risk GTN, 5 were cured with chemotherapy and one patient by lung resection only. Two patients with late relapses of low-risk GTN were cured with chemotherapy (EMA-CO) and hysterectomy/resection of uterus to achieve complete remission. As a result, all patients with relapses of low-risk GTN were cured, mainly (88%) by chemotherapy. Among 11 patients with early relapses of high-risk GTN, complete remission was achieved in 6 (55%) cases: in 2 patients as a result of EMA-EP chemotherapy, other patients needed combined approaches (chemotherapy + surgery). Three patients with recurrent course continue treatment, two patients died of progression. Of the 6 patients with late relapses of high-risk GTN, 4 (66%) patients were managed mainly through combined treatment (surgery + chemotherapy) and were cured. One patient continues treatment for more than 4 years, and one patient died of progression. In total, out of 17 patients with high-risk relapses, complete remission was achieved in 10 (59%) as a result of combined treatment in the majority of cases (80%). Conclusion. The optimal method of treatment for patients with relapses of low-risk GTN is chemotherapy; and for high-risk GTN combined approaches (chemotherapy + surgery)

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