Inadequate Medical Intervention (IMI) as a Prognostic Factor in High Risk Gestational Trophoblastic Neoplasia (HRGTN) Patients

ABSTRACT Introduction Successful treatment of HRGTN patients is related to experienced teams, adequate scoring and standard treatments. Chemotherapy is the cornerstone of therapy and the dose and timing has paramount importance. Objectives To evaluate the prognostic significance of IMI on mortality and morbidity in HRGTN setting. Methods Were reviewed clinical records of consecutive patients with gestational trophoblastic diseases who where evaluated and treated at Durand Hospital from 1990 to 2012. We selected HRGTN patients in two groups. Group 1, with IMI; and Group 2, without IMI. Results Three hundred fifty eight patients (pts) were recorded. Patients with HRGTN were 34 (9.49 %),median age 29 (r.14-42),median FIGO/OMS scoring were 11. Group 1 (21 pts) achieved cure (85.7%) with 2-6 lines of chemotherapy (median 4); three deaths were seen and all patients suffered grade 4 toxicity. Group 2 (13 pts) achieved cure (100%) with only one pt with second line chemotherapy, no grade 4 toxicity and no related mortality. Conclusions The IMI was an adverse prognostic factor and was related to increased toxicity. HRGTN is a curable disease. Patients with high-risk gestational trophoblastic neoplasia should be managed in consultation with individuals or facilities with expertise in the complex, multimodality treatment of these patients. Disclosure All authors have declared no conflicts of interest.