Results of treatment of patients with gestational trophoblastic neoplasia referred to the Brewer Trophoblastic Disease Center after failure of treatment elsewhere (1979-2006)

OBJECTIVE: To review treatment results of patients with gestational trophoblastic neoplasia (GTN) whose care was transferred to the Brewer Trophoblastic Disease Center after failure of treatment elsewhere from 1979-2006. STUDY DESIGN: Twenty-seven (6.6%) of 408 patients with GTN treated at the Brewer Center from 19792006 had received unsuccessful treatment at other institutions prior to transfer to our center. Outcomes were analyzed and compared with 37 patients who received secondary therapy at the Brewer Center from 1962-1978. RESULTS: Overall survival was 93% (25 of 27) in patients treated at the Brewer Center (1979-2006) after failed treatment elsewhere. The most common causes of treatment failure prompting referral to the Brewer Center were (1) use of a single-agent chemotherapy protocol to treat high-risk disease in 11 patients (41%), (2) inappropriate use of weekly methotrexate chemotherapy in 9 patients (33%), (3) failed sequential single-agent chemotherapy in 4 patients (15%), (4) use of the wrong multiagent chemotherapy for high-risk disease in 1 patient (4%) and (5) relapse from remission in 2 patients (7%). CONCLUSION: Successful secondary treatment of GTN improved from 59% during 1962-1978 to 93% during 1979-2006 as a result of better chemotherapy protocols and experience treating the disease.