Transvaginal ultrasound predicts delayed response to chemotherapy and drug resistance in Stage I low‐risk trophoblastic neoplasia

• Published in: Ultrasound in obstetrics & gynecology Vol. 40; no. 1; pp. 99 - 105
• Main Authors: Cavoretto, P., Gentile, C., MangilI, G., Garavaglia, E., Valsecchi, L., Spagnolo, D., MONTOLI, S., Candiani, M.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.07.2012; Wiley; Wiley Subscription Services, Inc
• Subjects: Adult; Antimetabolites, Antineoplastic - therapeutic use; Biological and medical sciences; Bones, joints and connective tissue. Antiinflammatory agents; Cardiovascular system; Diseases of mother, fetus and pregnancy; Doppler; Drug Administration Schedule; Drug Resistance, Neoplasm; Female; Gestational Trophoblastic Disease - diagnostic imaging; Gestational Trophoblastic Disease - drug therapy; Gestational Trophoblastic Disease - pathology; gestational trophoblastic neoplasia; GTN; Gynecology. Andrology. Obstetrics; Humans; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; methotrexate; Methotrexate - therapeutic use; Middle Aged; Neoplasm Staging; Pharmacology. Drug treatments; Predictive Value of Tests; Pregnancy; Pregnancy. Fetus. Placenta; Risk Factors; transvaginal ultrasound; Ultrasonic investigative techniques; Ultrasonography - methods; Vagina; Young Adult; Antineoplastic agent; Doppler ultrasound study; GTN; Trophoblaste pathology; Pregnancy disorders; Antifolate; Antirheumatic agent; Methotrexate; Ultrasound; transvaginal ultrasound; Sonography; Treatment resistance; Gynecology; Placenta diseases; Obstetrics; Pregnancy; Chemotherapy; Treatment; Antimetabolic; Transvaginal route; gestational trophoblastic neoplasia; Risk factor; Predictive factor; Doppler; Gestational trophoblastic disease
• ISSN: 0960-7692; 1469-0705
• DOI: 10.1002/uog.11097

Objectives Methotrexate (MTX) resistance is defined on the basis of the human chorionic gonadotropin (hCG) curve. The aim of this study was to identify low‐risk non‐metastatic patients with gestational trophoblastic neoplasia (GTN) who can achieve resolution by continuing MTX treatment despite a transient hCG plateau. Methods Before starting chemotherapy, 24 patients with FIGO Stage I GTN underwent transvaginal ultrasonography with power Doppler in order to identify myometrial lesions (areas of increased echogenicity and increased power Doppler signal). Ultrasound response to chemotherapy was defined when myometrial lesions decreased in echogenicity, Doppler signal or size. When ultrasound response occurred, despite chemoresistance defined by hCG values, MTX treatment was continued. Results MTX was continued in three out of seven chemoresistant patients because ultrasound suggested response to MTX. All three of these patients achieved a complete response, thus nearly halving the MTX‐resistance rate. Conclusion Among patients who are candidates for second‐line treatment on the basis of hCG, ultrasound may identify those in whom further MTX administration can induce a delayed complete response. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.