Gestational Trophoblastic Neoplasia Treatment at the Butaro Cancer Center of Excellence in Rwanda.

Autor:	Nzayisenga I; , , , and , Partners In Health-Inshuti Mu Buzima; , , , , , and , Rwandan Ministry of Health; , Human Resources for Health Program Rwanda, Kigali, Rwanda; , Ottawa University, Ottawa, Ontario, Canada; , , , , , and , Harvard Medical School; , , , , and , Brigham and Women's Hospital, Boston, MA; and , University of Minnesota Medical School, Minneapolis, MN, and Yale School of Medicine, New Haven, CT., Segal R; , , , and , Partners In Health-Inshuti Mu Buzima; , , , , , and , Rwandan Ministry of Health; , Human Resources for Health Program Rwanda, Kigali, Rwanda; , Ottawa University, Ottawa, Ontario, Canada; , , , , , and , Harvard Medical School; , , , , and , Brigham and Women's Hospital, Boston, MA; and , University of Minnesota Medical School, Minneapolis, MN, and Yale School of Medicine, New Haven, CT., Pritchett N; , , , and , Partners In Health-Inshuti Mu Buzima; , , , , , and , Rwandan Ministry of Health; , Human Resources for Health Program Rwanda, Kigali, Rwanda; , Ottawa University, Ottawa, Ontario, Canada; , , , , , and , Harvard Medical School; , , , , and , Brigham and Women's Hospital, Boston, MA; and , University of Minnesota Medical School, Minneapolis, MN, and Yale School of Medicine, New Haven, CT., Xu MJ; , , , and , Partners In Health-Inshuti Mu Buzima; , , , , , and , Rwandan Ministry of Health; , Human Resources for Health Program Rwanda, Kigali, Rwanda; , Ottawa University, Ottawa, Ontario, Canada; , , , , , and , Harvard Medical School; , , , , and , Brigham and Women's Hospital, Boston, MA; and , University of Minnesota Medical School, Minneapolis, MN, and Yale School of Medicine, New Haven, CT., Park PH; , , , and , Partners In Health-Inshuti Mu Buzima; , , , , , and , Rwandan Ministry of Health; , Human Resources for Health Program Rwanda, Kigali, Rwanda; , Ottawa University, Ottawa, Ontario, Canada; , , , , , and , Harvard Medical School; , , , , and , Brigham and Women's Hospital, Boston, MA; and , University of Minnesota Medical School, Minneapolis, MN, and Yale School of Medicine, New Haven, CT., Mpanumusingo EV; , , , and , Partners In Health-Inshuti Mu Buzima; , , , , , and , Rwandan Ministry of Health; , Human Resources for Health Program Rwanda, Kigali, Rwanda; , Ottawa University, Ottawa, Ontario, Canada; , , , , , and , Harvard Medical School; , , , , and , Brigham and Women's Hospital, Boston, MA; and , University of Minnesota Medical School, Minneapolis, MN, and Yale School of Medicine, New Haven, CT., Umuhizi DG; , , , and , Partners In Health-Inshuti Mu Buzima; , , , , , and , Rwandan Ministry of Health; , Human Resources for Health Program Rwanda, Kigali, Rwanda; , Ottawa University, Ottawa, Ontario, Canada; , , , , , and , Harvard Medical School; , , , , and , Brigham and Women's Hospital, Boston, MA; and , University of Minnesota Medical School, Minneapolis, MN, and Yale School of Medicine, New Haven, CT., Goldstein DP; , , , and , Partners In Health-Inshuti Mu Buzima; , , , , , and , Rwandan Ministry of Health; , Human Resources for Health Program Rwanda, Kigali, Rwanda; , Ottawa University, Ottawa, Ontario, Canada; , , , , , and , Harvard Medical School; , , , , and , Brigham and Women's Hospital, Boston, MA; and , University of Minnesota Medical School, Minneapolis, MN, and Yale School of Medicine, New Haven, CT., Berkowitz RS; , , , and , Partners In Health-Inshuti Mu Buzima; , , , , , and , Rwandan Ministry of Health; , Human Resources for Health Program Rwanda, Kigali, Rwanda; , Ottawa University, Ottawa, Ontario, Canada; , , , , , and , Harvard Medical School; , , , , and , Brigham and Women's Hospital, Boston, MA; and , University of Minnesota Medical School, Minneapolis, MN, and Yale School of Medicine, New Haven, CT., Hategekimana V; , , , and , Partners In Health-Inshuti Mu Buzima; , , , , , and , Rwandan Ministry of Health; , Human Resources for Health Program Rwanda, Kigali, Rwanda; , Ottawa University, Ottawa, Ontario, Canada; , , , , , and , Harvard Medical School; , , , , and , Brigham and Women's Hospital, Boston, MA; and , University of Minnesota Medical School, Minneapolis, MN, and Yale School of Medicine, New Haven, CT., Muhayimana C; , , , and , Partners In Health-Inshuti Mu Buzima; , , , , , and , Rwandan Ministry of Health; , Human Resources for Health Program Rwanda, Kigali, Rwanda; , Ottawa University, Ottawa, Ontario, Canada; , , , , , and , Harvard Medical School; , , , , and , Brigham and Women's Hospital, Boston, MA; and , University of Minnesota Medical School, Minneapolis, MN, and Yale School of Medicine, New Haven, CT., Rubagumya F; , , , and , Partners In Health-Inshuti Mu Buzima; , , , , , and , Rwandan Ministry of Health; , Human Resources for Health Program Rwanda, Kigali, Rwanda; , Ottawa University, Ottawa, Ontario, Canada; , , , , , and , Harvard Medical School; , , , , and , Brigham and Women's Hospital, Boston, MA; and , University of Minnesota Medical School, Minneapolis, MN, and Yale School of Medicine, New Haven, CT., Fadelu T; , , , and , Partners In Health-Inshuti Mu Buzima; , , , , , and , Rwandan Ministry of Health; , Human Resources for Health Program Rwanda, Kigali, Rwanda; , Ottawa University, Ottawa, Ontario, Canada; , , , , , and , Harvard Medical School; , , , , and , Brigham and Women's Hospital, Boston, MA; and , University of Minnesota Medical School, Minneapolis, MN, and Yale School of Medicine, New Haven, CT., Tapela N; , , , and , Partners In Health-Inshuti Mu Buzima; , , , , , and , Rwandan Ministry of Health; , Human Resources for Health Program Rwanda, Kigali, Rwanda; , Ottawa University, Ottawa, Ontario, Canada; , , , , , and , Harvard Medical School; , , , , and , Brigham and Women's Hospital, Boston, MA; and , University of Minnesota Medical School, Minneapolis, MN, and Yale School of Medicine, New Haven, CT., Mpunga T; , , , and , Partners In Health-Inshuti Mu Buzima; , , , , , and , Rwandan Ministry of Health; , Human Resources for Health Program Rwanda, Kigali, Rwanda; , Ottawa University, Ottawa, Ontario, Canada; , , , , , and , Harvard Medical School; , , , , and , Brigham and Women's Hospital, Boston, MA; and , University of Minnesota Medical School, Minneapolis, MN, and Yale School of Medicine, New Haven, CT., Ghebre RG; , , , and , Partners In Health-Inshuti Mu Buzima; , , , , , and , Rwandan Ministry of Health; , Human Resources for Health Program Rwanda, Kigali, Rwanda; , Ottawa University, Ottawa, Ontario, Canada; , , , , , and , Harvard Medical School; , , , , and , Brigham and Women's Hospital, Boston, MA; and , University of Minnesota Medical School, Minneapolis, MN, and Yale School of Medicine, New Haven, CT.
Jazyk:	angličtina
Zdroj:	Journal of global oncology [J Glob Oncol] 2016 Apr 13; Vol. 2 (6), pp. 365-374. Date of Electronic Publication: 2016 Apr 13 (Print Publication: 2016).
DOI:	10.1200/JGO.2015.002568
Abstrakt:	Purpose: Gestational trophoblastic neoplasia (GTN) is a highly treatable disease, most often affecting young women of childbearing age. This study reviewed patients managed for GTN at the Butaro Cancer Center of Excellence (BCCOE) in Rwanda to determine initial program outcomes. Patients and Methods: A retrospective medical record review was performed for 35 patients with GTN assessed or treated between May 1, 2012, and November 30, 2014. Stage, risk score, and low or high GTN risk category were based on International Federation of Gynecology and Obstetrics staging and the WHO scoring system and determined by beta human chorionic gonadotropin level, chest x-ray, and ultrasound per protocol guidelines for resource-limited settings. Pathology reports and computed tomography scans were assessed when possible. Treatment was based on a predetermined protocol stratified by risk status. Results: Of the 35 patients (mean age, 32 years), 26 (74%) had high-risk and nine (26%) had low-risk disease. Nineteen patients (54%) had undergone dilation and curettage and 11 (31%) had undergone hysterectomy before evaluation at BCCOE. Pathology reports were available in 48% of the molar pregnancy surgical cases. Systemic chemotherapy was initiated in 30 of the initial 35 patients: 13 (43%) received single-agent oral methotrexate, 15 (50%) received EMACO (etoposide, methotrexate, dactinomycin, cyclophosphamide, and vincristine), and two (7%) received alternate regimens. Of the 13 patients initiating methotrexate, three had their treatment intensified to EMACO. Four patients experienced treatment delays because of medication stockouts. At a median follow-up of 7.8 months, the survival probability for low-risk patients was 1.00; for high-risk patients, it was 0.63. Conclusion: This experience demonstrates the feasibility of GTN treatment in rural, resource-limited settings. GTN is a curable disease and can be treated following the BCCOE model of cancer care. Competing Interests: Authors’ disclosures of potential conflicts of interest and contributions are found at the end of this article.Gestational Trophoblastic Neoplasia Treatment at the Butaro Cancer Center of Excellence in RwandaThe following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO’s conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc.Ignace NzayisengaNo relationship to discloseRoanne SegalNo relationship to discloseNatalie PritchettNo relationship to discloseMary J. XuNo relationship to disclosePaul H. ParkNo relationship to discloseVedaste E. MpanumusingoNo relationship to discloseDenis G. UmuhiziNo relationship to discloseDonald P. GoldsteinNo relationship to discloseRoss S. BerkowitzNo relationship to discloseVedaste HategekimanaNo relationship to discloseClemence MuhayimanaNo relationship to discloseFidel RubagumyaNo relationship to discloseTemidayo FadeluNo relationship to discloseNeo TapelaNo relationship to discloseTharcisse MpungaNo relationship to discloseRahel G. GhebreNo relationship to disclose
Databáze:	MEDLINE
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