Response to initial treatment of low and intermediate risk gestational trophoblastic disease with methotrexate and folinic acid.

OBJECTIVES: To evaluate the response and toxicity of methotrexate and folinic acid given as primary treatment of low and intermediate risk gestational trophoblastic disease (GTD). MATERIAL AND METHOD: Medical records review was performed in patients who received methotrexate and folinic acid as a primary treatment of low and intermediate risk persistent GTD between January 1992 and December 2001. Response was defined as decline of beta human chorionic gonadotropin (hCG) to < or = 5 mlU/ml (remission) after methotrexate and folinic acid treatment. Response rate was estimated and factors associated with response were evaluated. RESULTS: Ninety four eligible patients were treated with intramuscular methotrexate and folinic acid. Complete remission was achieved in 64 cases (68%, 95% CI 58-78%). Mucositis (6.4%) and hepatotoxicity (6.4%) were the most common toxicity of methotrexate in the present study and none of these toxic effects was life threatening. Factors associated with response were initial serum hCG < or = 10,000 mlU/ml and stage I disease. CONCLUSION: Methotrexate with folinic acid is effective treatment for low and intermediate risk GTD with minimal severe toxicity.

Germ cell tumors of the ovary: A review of 644 cases.

This retrospective study reports 644 female patients with germ cell tumors of the ovary treated at Siriraj Hospital over a ten-year period from 1988-1997. The incidence was 38.7% of all ovarian tumors (1665 cases). Of the total, 608 patients (94.4%) had benign cystic teratomas and only 36 patients (5.6%) had malignant tumors. Dysgerminoma was the most common malignant germ cell tumor. Germ cell tumor was the most common malignant ovarian tumor in patients less than 20 years old. The mean age and parity of patients with benign tumor was significantly higher than those with malignant tumors (p<0.01). Benign tumors were often asymptomatic (35%) when the tumors were discovered but those with malignant tumors usually had symptoms and the most common symptoms was a palpable abdominal mass (47.2%). In the cases with benign tumors, more than two-thirds (73.7%) had a tumor less than 10 cm in length, but more than half (66.7%) of the patients with malignant tumors had an intermediate tumor between 11 and 20 cm long. Most of the patients in both groups had a unilateral tumor (p>0.05). Surgical treatment was conservative in 63.8% of patients with benign tumors, while only 30.6% of those with malignant tumors underwent conservative surgery (p<0.05).