TREATMENT OF NONMETASTATIC GESTATIONAL TROPHOBLASTIC TUMORS WITH SINGLE-AGENT METHOTREXATE CHEMOTHERAPY

Objective: The aim of present study was to evaluate the efficacy and toxicity of 5-day methotrexate singleagent chemotherapy and to detect factors associated with chemotherapy resistance in patients with nonmetastatic gestational trophoblastic tumors. Design: Prospective observational study. Setting: Al Hussein University Hospital, Al Galaa Maternity Teaching Hospital. Patients and methods: The study included 36 patients, 31(86.1%) were diagnosed during follow up after suctionevacuation of complete and partial hydatidiform moles. In 5 (13.9%) patients, the diagnosis followed spontaneous abortions and term pregnancy. All patients received methotrexate in a dose of 0.4mg /kg body weight for 5 consecutive days then 9 days ofrest. Courses were repeated so long no methotrexate toxicity. Follow up was done clinically and by fi-subunit of human chorionic gonadotropin. Results: It was observed that complete remission occurred in 32 (88.9%) patients with methotrexate alone.Resistance developed in 4 (11.1%) patients, 3 (8.3%) of them cured with sequential single-agent actinomycin D and one (2.8%) patient undergone hysterectomy. Factors associated with resistance were duration of symptoms 4months, non-molar antecedent pregnancy, pretreatment level of β-hCG 100,000m lU/mL and histopathologic diagnosis of choriocarcinoma. Minor toxic effects of methotrexate developed in 13 (36.1 % ) patients, while major toxic effects occurred in 2 (5.6%) patients in form of stomatitis and skin rash. Conclusion: It could be concluded that in a small series of patients with nonmetastatic gestational trophoblastic tumor,5-day methotrexate smgle-agent chemotherapy is well-tolerated and highly effective treatment.