| Abstrakt: |
Objective: To evaluate the clinical outcomes and treatment strategies in patients with gestational trophoblastic neoplasia (GTN) treated at a tertiary care center in North India, with a focus on response to methotrexate-based chemotherapy and the factors influencing the need for escalation to more intensive regimens. Methods: A prospective observational study was conducted on 15 patients diagnosed with GTN from June 2023 to June 2024 at a tertiary care center. The mean age of the cohort was 24.6 years. All patients were initially diagnosed following a molar pregnancy, with a mean interval of 4.57 months between the antecedent pregnancy and diagnosis. Treatment regimens primarily included methotrexate and folinic acid (Mtx + FA), with 23.1% of patients requiring escalation to the more aggressive EMA-CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine) regimen due to inadequate response. Lung metastasis was identified as a key factor leading to treatment escalation. Results: Of the 15 patients, the majority were initially treated with the Mtx + FA regimen. Approximately 23.1% (n=3) of patients required a switch to the EMA-CO regimen due to insufficient response to the initial treatment. Lung metastasis was a major determinant for escalating therapy in patients who were considered low-risk based on WHO and FIGO staging criteria. Despite these challenges, all patients achieved complete remission, either through initial therapy or after escalation to more aggressive regimens. Conclusion: This study underscores the significance of individualized treatment approaches for patients with GTN, particularly in the presence of metastasis, to ensure optimal outcomes. Timely risk stratification based on WHO scoring and FIGO staging is critical in determining the appropriate chemotherapy regimen. |
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