Abstract
Objective: (a) To describe the demographic characteristics of malignant gestational trophoblasic disease (GTD) in Mosul. (b) To evaluate the classification system that stratifies the treatment of the malignant GTD. (c) To know the incidence of malignant changes of mole to malignant GTD.Design: retrospective clinical case series study done over a period of 5 years.Setting: Al-Batool Maternity Teaching Hospital and Ibn Seena Teaching Hospital.Participants: The records of a series of 17 consecutively treated patients who had been diagnosed to have malignant GTD were reviewed. The records of these 17 patients were studied for their age, parity, and mode of presentation. All patients underwent staging studies which included chest x-ray and abdominal ultrasound and were classified as good prognosis group 8 patients (47%) and poor prognosis group 9 patients (53%). Intervention(s): The good prognosis group was treated with courses of intramuscular methotrexate (50 mg on alternative days 1,3,5,7) with folinic acid rescue (7.5 mg orally on alternative days 2,4,6,8) .The poor prognosis group was treated with methotrexate (10 mg/m2 /day) intravenously (iv), dactinomycin (0.3 mg/m2 /day) iv, and cyclophosphamide (110 mg/m2 /day) iv, for three-day course. Both courses were repeated according to patients’ response. Results: The mean age incidence of malignant GTD was 37.2 years; the mean parity was 4.6, equally presented from rural and urban areas. The presenting symptom of malignant GTD was vaginal bleeding in 47%, cough and shortness of breath in 41.1%, cough and hemoptysis in11.7%. The blood group was O+ve in 64.7%, A+ve in 17.5%, B+ve in 11.7% and AB+ve in 5.9%. The antecedent pregnancy for malignant GTD was complete mole in 88.2 % (the entire good prognosis group), term pregnancy in 5.9% and abortion in 5.9% (both of them in the poor prognosis group). The mean duration between the antecedent pregnancy and treatment of malignant GTD was 5.7 months. Complete response rate without recurrence was 75% for the good prognosis group and 44.4% for the poor prognosis group. The mortality rate was 0% for the good prognosis group and 33.3% for the poor prognosis group giving an overall cure rate of 58.8%. Hysterectomy was needed in 2 patients (22.2%) of the poor prognosis group. The ratio of changes from complete mole to malignant GTD was about one to nine. Conclusion: Malignant GTD usually complicated complete mole and presented as poor prognosis type in nearly half of the patients. Classification into good and poor prognosis groups is a successful way for treatment selection. Key words: Gestational trophoblastic disease, hydatidiform mole, neoplasm staging.
