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, Juhriyani M Lubis, Deri Edianto, Hotma P Pasaribu,
Edy Ardiansyah, Iman Helmi Effendy
Department of Obstetrics and Gynecology, Medical School of Universitas Sumatera Utara
Medan, Indonesia
Background:
Gestational Trophoblastic Neoplasia is a malignancy that is very sensitive to methotrexate, but the
resistance limits the effectiveness. Monitoring of serum -hCG during chemotherapy is important
to know the success of chemotherapy and prediction the chemo resistance. Therefore, we need to
know the regression curve of serum -hCG for early identification of methotrexate resistance.
Aim:
The objective of this study was 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.
Materials and Methods:
This study is a descriptive research with case series design. Between January 2010 and
December 2014 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 was reviewed. Low risk gestational trophoblastic neoplasia includes non
metastatic neoplasia (except lung metastasis) where the WHO score is 6 or less in FIGO Stage I
III. Methotrexate was given with dose 0.4 mg/kg intravenously for 5 days, repeated every 2 weeks.
All the measurements of total -hCG in serum were performed with sensitive and specific radioimmunoassays (RIAs) that have been developed in our laboratory. The value of normal -hCG
serum is 5 IU/mL. 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:
All of 34 patients with low risk gestational trophoblastic neoplasia were cured. But 12 patients were
drop out because they did not finish their treatment before complete remission. We had 15
patients in complete remission group and 7 patients in MTX-resistant group.
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 and 97.5 percentile.

2.5% of patients has normal value of -hCG after 2 nd cycle of methotrexate administration, 50% of
patients has normal value of -hCG after 4 th cycle of methotrexate administration and 97.5% of
patients has normal value of -hCG after 10 th cycle of methotrexate administration. The highest
value of -hCG of complete remission group is 279.289 mIU/ml in the 97.5 percentile.
Picture 2. -hCG regression curve of complete remission group of low risk gestational
trophoblastic neoplasia who treated with single methotrexate chemotherapy combine with
MTX-resistance group.

Before starting chemotherapy, 2 patients of the 7 patients of MTX-resistant group (28.5%) are
above the 97.5 percentile of complete remission group. Before the 2 nd cycle, 3 patients (42.8%) of
the 7 patients are above 97.5 percentile. Before the 4 th cycle, 5 patients (100%) of 5 patients who
were still undergoing chemotherapy until the end of the cycle are above the 97.5 percentile.
Conclusion:
1. 50% of patients in complete remission group reached normal value after 4 nd cycle.
2. -hCG serum level higher than 105 IU/mL had complete remission after 10th cycle
3. MTX-resistant group had -hCG serum level higher than complete remission group before
chemotherapy.
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Lurain JR. Gestational Trophoblastic Disease : Epidemiology pathology clinical presentation and Diagnosis of Gestational Trophoblastic
Disease and Management of Hydatidiform Mole. Am J Obstet Gynecol. 2010. 531-9.
Deep JP, Sedhai LB, Napit J, Pariyar J. Gestational Trophoblastic Disease. Journal of Chitwan Medical College 2013;3(4):4-11.
Ngan HY, Kohorn EI, Cole LA, et al; FIGO Cancer Report 2012 : Trophoblastic Disease. Int J Gynecol Obstet 2012; 83(Suppl 1):1757130-6.
May T, Goldstein DP, Berkowitz RS. Chemotherapy Research and Practice : Current Chemotherapeutic Management of Patient with
Gestational Trophoblastic Neoplasia. Hindawi Publishing Corp. 2011. Available from : http://www.hindawi.com/journals/cherp/2011/806256/
Aghajanian C. Treatment of Low-Risk Gestational Trophoblastic Neoplasia. J Clin Oncol. 2011:786-8
McNeish IA, Strickland S, Holden L, Rustin GJ, Foskett M, Seckl MJ, et al. Low- risk persistent gestational trophoblastic disease: outcome
after initial treatment with low-dose methotrexate and folinic acid from 1992 to 2000. J Clin Oncol 2002;20(7):183844.
Maesta I, Growdon WB, Goldstein DP, et al. Prognostic factors associated with time to hCG remission in patients with low-risk post-molar
gestational trophoblastic neoplasia. Gynecol Oncol 2013;130:312316.
Trommel V, Massuger, L. F.; Schijf, C. P.; Ten Kate-Booij, M. J.; Sweep, F. C., and Thomas, C. M. Early Identification of Resistance to FirstLine Single-Agent Methotrexate in Patients With Persistent Trophoblastic Disease. J Clin Oncol 2006;24:52-58.
Seckl MJ, Sebire NJ, Berkowitz RS. Gestational trophoblastic disease. Lancet 2010; 376: 717729.
Seckl MJ, Sebire NJ, Fisher RA, Golfier F, Massuger L, Sessa Cet et al. Gestational Trophoblastic Disease: ESMO Clinical Practice
Guidelines for diagnosis, treatment and follow-up, , Ann Oncol. 2013;Vol: 24:39-50.