ABSTRACT
Background: Gestational trophoblastic disease (GTD) comprises a spectrum of diseases ranging from molar pregnancy to malignant gestational trophoblastic neoplasia (GTN). GTN are highly chemo-sensitive tumours which are treated as per FIGO risk stratification. The rarity of the disease limits the evidence regarding the disease to case series and reports. The objective of this study was to study incidence, baseline characteristics of patients and clinical outcome of GTN patients treated at this centre.Methods: This is a retrospective descriptive study based on medical records of patients of GTD who were registered in department of medical oncology, from January 2015 to December 2018 (4 years). GTN was diagnosed based on serum beta HCG values. Their baseline characteristics, risk score, serum β HCG levels, and treatment regimens were investigated. The incidence of GTD and response to treatment were analysed.Results: Out of 211 GTD patients, 56 developed GTN. The incidence was 3.4 per 10000 deliveries. Low risk cases (n=38) were treated with methotrexate and actinomycin in first line while high risk cases received EMACO and EP followed by EMACO as the first line. A cure rate of 100% for low risk cases and 94.4% (n=17) for high risk cases were recorded. Resistance to MTX was 32.3% while EMACO was resistant in 46.6% as first line. Neutropenia and alopecia were the most common treatment related adverse events. Predictors of resistance to single agent in low risk GTN include higher pre-treatment βHCG values and higher risk scores.Conclusions: GTN exemplifies a rare, highly aggressive but curable malignancy. Serum βHCG is the most reliable diagnostic as well as prognostic marker in management of GTD. EMACO is the preferred regimen for high risk GTN. FIGO staging and risk stratification help in individualizing the treatment to ensure maximum response to therapy thus making GTN a curable malignancy.
ABSTRACT
Introduction: Gastric cancer is the second leading cause ofcancer death worldwide, with a 5-year survival rate of lessthan 20%. About 25% of patients with gastric cancer presentwith disseminated disease and more than half of those withapparently localized disease recur within 5 years. Study aimedto evaluate the response rate, median PFS, overall survivaland toxicity to 3 Weekly Cisplatin/5-Fluorouracil Vs Weekly5-Fluorouracil in patients with advanced gastric cancer.Material and Methods: Patients were recruited forchemotherapy with Cisplatin 75mg/mg2 in divided dosesand 5-Fluorouracil 750mg/m2 for 3 days in every 21 daysfor 6 cycles in one arm and 20 patients for treatment withWeekly 5- Fluorouracil 500mg for 16 weeks. Within twomonths of completion of chemotherapy, CT abdomen wasdone to compare with the baseline CT abdomen to assess theresponse rate using RESIST criteria Version V1.1. Also theimprovement in ECOG PS was ascertained as an endpoint.Results: In the Cisplatin /5FU arm had an overall response rateof 20%, median PFS of 6 months,45% had a partial response(PR), 10% had stable disease (SD) 25% had progression(PD), 20% achieved CR and more of haematological andnon-hematological toxicity. In the 5FU arm, 35% had stabledisease (SD),40% had progression (PD) 5% achieved CR andless of haematological and non-hematological toxicity.Conclusion: In advanced gastric cancer, Cisplatin /5FU hadmore response rate, more median PFS and more toxicity.Weekly 5FU is better tolerable regimen with