Hema Sreedharan Nair1
Gestational trophoblastic disease is a spectrum of proliferative abnormalities of the trophoblast. GTD represents a benign form of the disease while GTN is the malignant often metastatic lesion. 75-80 per cent of patients initially diagnosed as GTD will follow a benign course after dilatation and curettage. 15-20 per cent develop locally invasive disease and 3-5 per cent develop metastatic lesions. The study aims to assess the proportion of gestational trophoblastic neoplasia among women with gestational trophoblastic disease and identify the risk factors for chemotherapy in gestational trophoblastic neoplasia.
MATERIALS AND METHODS
This is a case-control study conducted in a tertiary hospital during a 5-year period. Cases are gestational trophoblastic neoplasia diagnosed by either rising beta-HCG levels or plateauing beta-HCG levels or by histological evidence of choriocarcinoma. Controls are cases of gestational trophoblastic disease post evacuation with normal HCG regression at 8 weeks. There were 306 controls and 57 cases.
Tabulated and analysed using SPSS package. Of the 363 patients of gestational trophoblastic disease, 57 (15.7%) needed chemotherapy. 98.2% belonged to the age group of 20-35 years. 63% had gestational age of more than 12 weeks, 56.1% had pre-evacuation HCG of more than 40,000. 15.7% needed combination therapy.
1. 83.1% of patients belonged to age group of 20-30 years.
2. Blood group distribution of patients with gestational trophoblastic disease did not show any significance.
3. 15.7% of total patients were diagnosed to have gestational trophoblastic neoplasia that necessitated chemotherapy.
4. When uterine size was more than 12 weeks, a statistically significant number of patients needed chemotherapy compared to non-chemotherapy group.
5. When BHCG values were more than 40,000, a statistically significant number of patients needed chemotherapy.
6. A risk score of seven or more was found to have a significant association in the chemotherapy group.
7. The major indications for chemotherapy were plateauing of HCG, rising HCG, rise in HCG 6 months after evacuation and invasive mole.
8. Single agent chemotherapy with methotrexate and folinic acid was used in 84.2% cases.
9. Combination therapy with EMACO was used in 15.7%.
10. Indication for combination therapy was methotrexate resistance-3 cases and high risk WHO score (>7)-6 cases.