Reproductive outcomes after multiagent chemotherapy for high-risk gestational trophoblastic neoplasia

J Reprod Med. May-Jun 2014;59(5-6):204-8.

Abstract

Objective: To analyze the reproductive outcomes of women with high-risk gestational trophoblastic neoplasia (GTN) treated with multiagent EMA-CO chemotherapy.

Study design: Of 212 patients treated with chemotherapy for GTN between 1986 and 2012, 65 (31%) could be contacted by telephone or mail and consented to participate in a questionnaire designed to assess their menstrual and reproduction outcomes.

Results: Twenty-four high-risk (HR) and 41 low-risk (LR) patients consented to the study. Fifteen (63%) HR and 34 (83%) LR women had not undergone hysterectomy (p = 0.08). Of the 12 HR and 33 LR women who could recall their menstrual history, all 12 (100%) HR and 32 (97%) LR women resumed menses after chemotherapy. Both groups also had a similar age of menopause (HR, 43.8 years; LR, 48.5 years) (p = 0.19). Although fewer women in the HR group desired to become pregnant after chemotherapy (HR 5/15 [33%] vs. LR 25/34 [74%]) (p = 0.01), 8 HR women (53%) and 29 LR women (85%) eventually became pregnant (p = 0.03), with equivalent live birth rates of 74% and 76%, respectively.

Conclusion: Multiagent EMA-CO chemotherapy did not significantly alter menstrual or reproductive outcomes compared to single-agent methotrexate chemotherapy for GTN.

MeSH terms

  • Adult
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Cyclophosphamide / adverse effects
  • Cyclophosphamide / therapeutic use
  • Dactinomycin / adverse effects
  • Dactinomycin / therapeutic use
  • Etoposide / adverse effects
  • Etoposide / therapeutic use
  • Female
  • Gestational Trophoblastic Disease / drug therapy*
  • Humans
  • Hysterectomy
  • Live Birth
  • Menstruation / drug effects
  • Methotrexate / adverse effects
  • Methotrexate / therapeutic use
  • Middle Aged
  • Pregnancy
  • Pregnancy Outcome
  • Reproduction*
  • Risk Factors
  • Surveys and Questionnaires
  • Treatment Outcome*
  • Vincristine / adverse effects
  • Vincristine / therapeutic use

Substances

  • Dactinomycin
  • Vincristine
  • Etoposide
  • Cyclophosphamide
  • Methotrexate

Supplementary concepts

  • EMA-CO protocol