Analysis of Clinical Characteristics and Outcomes in 7 Patients with Re-recurrent Gestational Trophoblastic Neoplasia

OBJECTIVE: To analyze the clinical characteristics and outcomes of patients with re-recurrent gestational trophoblastic neoplasia (GTN). STUDY DESIGN: A total of 547 patients with typical GTN at our institution from 2000-2012 were enrolled in this retrospective study. Of 547 cases, 29 relapsed after initial remission, and 7 of 29 patients with recurrent GTN had repeat relapses. The detailed clinical characteristics of patients with re-recurrent GTN were evaluated. RESULTS: The recurrence and re-recurrence rates in 547 patients with GTN were 5.3% and 24%, respectively. In 7 patients with re-recurrent GTN the mean age was 43 years. The mean level of serum beta-hCG before each treatment was 11,405 IU/L. The mean time interval from last treatment to recurrence was 38 months. All 7 patients received first- and second-line chemotherapy, and 4 of them required salvage chemotherapy. The total number of chemotherapy courses administered was 137 (mean=6). In conjunction with chemotherapy, surgery was performed in all 7 patients. After final treatment 7 patients had a median follow-up of 20 months. Although 1 died secondary to disease progression, the remaining 6 achieved serologic complete remission. CONCLUSION: Our analysis suggests that surgical intervention and intensive chemotherapy could be equally important for the treatment of the patients with re-recurrent GTN. Be cause the patients have a favorable prognosis, the principles of treatment for re-recurrent GTN should strive to cure disease rather than simply relieve the symptoms of disease or delay the time of relapse.