REGRESSION CURVES OF -HUMAN CHORIONIC SERUM GONADOTROPIN IN LOW RISK

GESTATIONAL TROPHOBLASTIC NEOPLASIA PATIENTS WHO TREATED WITH SINGLE

METHOTREXATE CHEMOTHERAPY AT RSUP. H. ADAM MALIK MEDAN
Sarah Dina, Deri Edianto, Hotma P Pasaribu, Edy Ardiansyah,
Iman Helmi Effendi, Juhriyani M Lubis
Department of Obstetrics and Gynecology
School of Medicine Universitas Sumatera Utara
Medan, Indonesia
Objective:
To determine the regression curve of -hCG serum patients with low-risk gestational trophoblastic
neoplasia who treated with single methotrexate chemotherapy at RSUP. H. Adam Malik Medan.
Design:
This study is a descriptive research with case series design.
Materials and Methods:
The complete medical records of all the low risk gestational trophoblastic neoplasia patients who
received a single methotrexate chemotherapy registered at RSUP. H. Adam Malik Medan between
January 2010 and December 2014 were reviewed. We exclude the medical records of
inobidienced patients. We record the number of chemotherapy cycles and the level of -hCG
serum before and after every cycle of chemotherapy from complete remission and resistance
groups. The level of -hCG serum described on the curve and analyzed descriptively.
Results:
We achieved 34 patients medical record with 12 drop out
Picture 1. -hCG regression curve of complete remission of low risk gestational
trophoblastic neoplasia who treated with single methotrexate chemotherapy, described in
2.5 , 50 dan 97.5 percentile.
1,000,000.00

100,000.00

10,000.00
2.5th percentile
50th percentile

1,000.00

97.5th percentile
normal value of -hCG (upper
limit)

100.00

10.00

1.00
0

10 11 12

2.5% of patients had normal value of -hCG after 2 nd cycle of methotrexate administration, 50% of
patients had normal value of -hCG after 4 th cycle of methotrexate administration and 97.5% of
patients had normal value of -hCG after 10 th cycle of methotrexate administration. There are
variations of -hCG regression in the 50 th percentile group, where there is an increase of -hCG
after normal value in 8th cycle and decrease in 9th cycle to normal.

Picture 2. -hCG regression curve of complete remission group of low risk gestational
trophoblastic neoplasia who treated with single methotrexate chemotherapy, combine with
-hCG curves of MTX resistance group.
1,000,000.00

100,000.00

10,000.00

1,000.00

100.00

2.5th percentile

50th percentile

97.5th percentile

MTX resistance patient 1

MTX resistance patient 2

MTX resistance patient 3

MTX resistance patient 4

MTX resistance patient 5

MTX resistance patient 6

MTX resistance patient 7

normal value of -hCG (upper

limit)

10.00

1.00
0123456789
111
0
12

Before starting chemotherapy, 2 patients of the 7 patients of MTX-resistant group (28.5%) are
above the 97.5th percentile of complete remission group. Before the 2 nd cycle, 3 patients (42.8%) of
the 7 patients are above 9.75th percentile. Before the 4th cycle, 5 patients (100%) of 5 patients who
were still undergoing chemotherapy until the end of the cycle are above the 97.5 th percentile.
Conclusion:
1. 97.5% of patients in complete remission group reached normal value at 10 th cycle.
2. MTX resistant group had -hCG serum level higher than complete remission group before
chemotherapy.
3. -hCG regression curve of complete remission group had decreased value -hCG faster
than MTX resistant group curve.