The changing role of thoracotomy in gestational trophoblastic neoplasia at the New England Trophoblastic Disease Center.

Abstract

OBJECTIVE:

To review our experience with thoracotomy in gestational trophoblastic neoplasia (GTN).

STUDY DESIGN:

Nineteen thoracotomy patients from our database were identified. Thoracotomy was performed for therapeutic reasons in 11 patients and to clarify the diagnosis in eight.

RESULTS:

Among the 11 patients with chemotherapy-resistant pulmonary tumors, 10 of 11 (90.9%) achieved remission with thoracotomy. Thoracotomy was more likely to be done to clarify diagnosis before 1980 (83%) than after 1980 (23%) (p = 0.04), when it became more likely to be done for therapeutic indications. Ten patients had solitary lung lesions and 9 had multiple lesions. Four patients died (21%), with an average survival after thoracotomy of 149 days; patients had bilateral or multiple lung lesions, median preoperative hCG was 58,000 mIU/mL and all were stage IV. Survivors had lower stage disease, were more likely to have solitary lesions and had lower preoperative hCG levels.

CONCLUSION:

There have been several temporal changes in the indications for thoracotomy for GTN. In general, the optimal patient to achieve remission with thoracotomy will have stage III disease, a preoperative hCG of < 1,500 mIU/mL, and a solitary lung nodule resistant to chemotherapy. Likelihood of remission after thoracotomy is high in properly selected patients.

• Authors: Evelyn L Fleming, Leslie Garrett, Whitfield B Growdon, Michael Callahan, Nicole Nevadunsky, Sue Ghosh, Donald P Goldstein, Ross S Berkowitz
• Journal: The Journal of reproductive medicine (J Reprod Med) Vol. 53 Issue 7 Pg. 493-8 (Jul 2008) ISSN: 0024-7758 [Print] United States
• PMID: 18720924 (Publication Type: Journal Article)

Topics

• Adult
• Choriocarcinoma (secondary, surgery)
• Female
• Gestational Trophoblastic Disease (surgery)
• Humans
• Lung Neoplasms (secondary, surgery)
• Pregnancy
• Thoracotomy
• Uterine Neoplasms (pathology)
• Young Adult