Role of computed axial tomography of the chest in staging patients with nonmetastatic gestational trophoblastic disease.

Abstract

Thirty-nine women with nonmetastatic gestational trophoblastic disease as determined by conventional staging studies were prospectively evaluated with computed axial tomography (CAT) of the lungs. Sixteen patients (41%) had pulmonary micrometastases detected by CAT, which were not detected by routine chest x-ray. Eight patients (20.5%) had indeterminate scans, and only 15 patients (38%) had negative scans. Eight of 16 patients (50%) with pulmonary micrometastases failed initial therapy with methotrexate-folinic acid rescue while one of eight (12.5%) patients in the indeterminate group and one of 15 (6.7%) patients in the true nonmetastatic group failed initial therapy (P less than .006). All patients who failed methotrexate-folinic acid rescue ultimately achieved prolonged remission with actinomycin D. Time to remission was significantly decreased in patients without evidence of pulmonary micrometastases (P = .03), but the total number of courses of chemotherapy was not significantly different (P = .06). No life-threatening toxicity occurred. Pulmonary micrometastases detected by CAT but not chest x-ray are predictive of an increased risk of methotrexate-folinic acid therapy failure. Computed axial tomography of the lungs identifies a group of patients at high risk for failure of methotrexate-folinic acid rescue, and, therefore, may be indicated for routine staging of patients with otherwise nonmetastatic gestational trophoblastic disease.

• Authors: D G Mutch, J T Soper, M E Baker, L C Bandy, E B Cox, D L Clarke-Pearson, C B Hammond
• Journal: Obstetrics and gynecology (Obstet Gynecol) Vol. 68 Issue 3 Pg. 348-52 (Sep 1986) ISSN: 0029-7844 [Print] United States
• PMID: 3016626 (Publication Type: Journal Article)

Chemical References

• Chorionic Gonadotropin
• Leucovorin
• Methotrexate

Topics

• Adolescent
• Adult
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Chorionic Gonadotropin (blood)
• Female
• Humans
• Leucovorin (therapeutic use)
• Lung Neoplasms (diagnostic imaging, drug therapy, secondary)
• Methotrexate (therapeutic use)
• Middle Aged
• Neoplasm Staging
• Pregnancy
• Tomography, X-Ray Computed
• Trophoblastic Neoplasms (diagnostic imaging, drug therapy, secondary)
• Uterine Neoplasms