Successfully conservative treatment of large cervical choriocarcinoma with profuse vaginal bleeding.

Primary choriocarcinoma of the uterine cervix is a rare disease. The accurate diagnosis of such a disease is difficult to achieve because of its rarity. Furthermore, the majority of cases presented with abnormal vaginal bleeding that could be caused by other more common conditions including, threatened abortion, cervical polyp, cervical pregnancy, or cervical cancer. In the present report, the authors present a case of large cervical choriocarcinoma with life-threatening vaginal bleeding, which was initially misdiagnosed as a cervical cancer The active cervical bleeding was successfully controlled with selective uterine arterial embolization. Remission of cervical choriocarcinoma was accomplished with combination chemotherapy without the need of hysterectomy.

Clinical relevance of atypical squamous cells of undetermined significance by the 2001 bethesda system: experience from a cervical cancer high incidence region.

The aim of this study was to evaluate the underlying lesions and factors predicting cervical intraepithelial neoplasia (CIN) 2+ in women who had 'atypical squamous cells of undetermined significance' (ASC-US) on cervical cytology in the region with a high incidence of cervical cancer. This study was prospectively conducted at Chiang Mai University Hospital, Chiang Mai, Thailand. All women with ASC-US cytology undergoing colposcopic evaluation between October 2004 and August 2008 were recruited. During the study period, 208 women were enrolled. Mean age was 44.4 years. The histopathologic results at the initial evaluation were as follows: CIN 2-3, 21 (10.1%); adenocarcinoma in situ, 3 (1.4%); cancer, 5 (2.4%); CIN 1, 26 (12.5%); and no lesions, 153 (73.6%). Multivariate analysis revealed that nulliparity (adjusted odds ratio [aOR] =4.09; 95% confidence interval [CI] = 1.04-16.10) and current oral contraceptive use (aOR=2.85; 95%CI= 1.14-7.15) were independent predictors for having CIN 2+ at the initial colposcopy. At the median follow-up time of 6.7 months, CIN 2-3 lesions were additionally detected in 2 women. In conclusion, ASC-US cytology in our population has a relatively high prevalence of underlying invasive carcinoma. Nulliparity and current oral contraceptive use are independent predictors for harboring CIN 2+.

Accuracy of intra-operative frozen sections in the diagnosis of ovarian masses.

The accuracy of frozen section diagnosis in the intraoperative evaluation of ovarian masses is very important with regard to surgeon selection of appropriated operating procedures. For evaluation in our institute, the records of 127 patients with ovarian masses submitted for intraoperative frozen sections between January 2001 and December 2005 were reviewed. After exclusion of 4 completely infarcted masses and 11 cases with deferred frozen section diagnoses, 112 were analyzed for diagnostic accuracy by comparing with the final histologic results. We found sensitivity in the diagnosis of benign, borderline and malignant tumors to be 100%, 84%, and 92 %, respectively, with specificities of 92.7%, 97.9%, and 100%, respectively. The overall accuracy with frozen sections was 94 %. Among 18 patients with deferred or discordant diagnoses, mucinous tumors accounted for 72 % of cases. No over-diagnosis of malignancy or misdiagnosis of metastatic lesions as primary ovarian cancer by frozen sections was observed. In conclusion, the accuracy of intraoperative frozen section for the diagnosis of ovarian masses is high. Frozen sections also help in the evaluation of metastatic tumors to the ovary. Mucinous tumors constitute an important group causing diagnostic discrepancies.

Outcome of interval debulking in advanced ovarian cancer patients.

Interval debulking and neoadjuvant chemotherapy have been used in management of advanced epithelial ovarian cancer for many years in order to achieve optimal residual disease and reduce surgical morbidity. The present study was conducted to evaluate the outcomes of advanced ovarian cancer patients treated with these two approaches prior to cytoreductive surgery in Chiang Mai University Hospital between January 2001 and December 2006. The medical records of 29 patients who met the criteria were retrospectively reviewed. Most had stage IIIC serous cystadenocarcinomas. We found that the 5-year progression free survival and overall survival were 10% and 22% while the median values were 13 months and 34 months, respectively. Multivariate analysis showed that a suboptimal residual tumor volume was a statistically significant adverse prognostic factor for overall survival. In conclusion, interval debulking surgery and neoadjuvant chemotherapy before cytoreductive surgery lead to a more favorable outcome with advanced epithelial ovarian cancers.

Appropriate interval for repeat excision in women undergoing prior loop electrosurgical excision procedure for cervical neoplasia.

The objective of the present study was to evaluate the impact of intervals on complications and pathological examination in women undergoing a repeat loop electrosurgical excision procedure (LEEP) for cervical neoplasia. During October 2004 and January 2007, 78 women who had undergone repeat LEEP at Chiang Mai University Hospital, were prospectively evaluated. The mean age was 47.5 years (range; 27-69 years). The mean duration of uncomplicated vaginal bleeding was 4.4 days (range; 1-20 days). The occurrence of persistent vaginal bleeding was noted in 9 women. Among 78 women, 2 (2.56%) and 7 (8.97%) experienced intraoperative and postoperative hemorrhage, respectively. Six (7.69%) had postoperative infection. These complications were not significantly different from those observed in women undergoing first LEEP in the same period (P=0.56). There was no significant difference in the incidence of perioperative complications and the incidence of non-evaluable cone margins among women who undergoing repeat LEEP within 4-6 weeks, between 6-8 weeks, and more than 8 weeks after first LEEP. In conclusion, repeat LEEP could be safely performed 4-12 weeks after the first procedure without any impact on pathological specimen examination.

Lymphovascular space invasion as a prognostic determinant in uterine cancer.

The objective of this study was to evaluate the clinical significance of lymphovascular space invasion (LVSI) in patients with uterine cancer in terms of lymph node metastasis, recurrence and survival rate. A total of 190 patients with newly diagnosed uterine cancer who underwent total abdominal hysterectomy (TAH), bilateral salpingo-oophorectomy (BSO), omentectomy, peritoneal washing or ascitic fluid collection, and pelvic/paraaortic lymph node sampling at Chiang Mai University Hospital between January 1999 and December 2004 were evaluated. All medical records and histopathologic slides were retrospectively reviewed to determine the relationship between LVSI and clinicopathological characteristics. LVSI was present in 79 patients (42%) and significantly correlated with lymph node metastasis (p0.001), BMI 25 kg/m2 (p0.001), advanced FIGO stage (p 0.001), poor histologic grade (p0.001), and deep uterine invasion (p0.001). Patients with LVSI, when stratified by FIGO stage, also had a significant lower 5-year survival rate. For those who had disease recurrence, LVSI and histologic grade were found to be independent prognostic factors in a multivariate analysis. LVSI was one of the prognostic determinants for disease recurrence and associated with poor survival in patients with uterine cancer.

Factors affecting residual lesion in women with cervical adenocarcinoma in situ after cone excisional biopsy.

The objective of this study was undertaken to evaluate the factors affecting residual lesion in women with adenocarcinoma in situ (AIS) on cervical conization specimens. The medical records of women with AIS who had no associated invasive carcinoma after cervical conization and underwent subsequent hysterectomy at Chiang Mai University Hospital were reviewed. During March 1998 and March 2006, 45 women were included for analysis. The mean age was 45.2 years (range, 30-66 years). Thirteen (28.9%) women presented with AIS on Pap smear. Thirty (66.7%) underwent loop electrosurgical excision procedure and the remaining 15 (33.3%) underwent cold-knife conization. Twenty (44.4%) women had mixed lesions of AIS and squamous intraepithelial lesion on cervical specimens. Surgical cone margins were clear in 25 (55.6%) women. Eighteen (40%) and two (4.4%) women had involved and non-evaluable cone margins, respectively. Residual lesion was noted in 14 (31.1%) hysterectomy specimens. There was no residual lesion in women with clear cone margins while 72% and 50% of women with involved and non-evaluable cone margins, had residual lesion, respectively. These differences were statistically significant (P<0.001). No significant association between the ECC results and the residual lesion was noted (P=0.29). In conclusion, approximately one-third of women with AIS on cervical conization have residual lesion on subsequent hysterectomy specimens. Only cone margin status is a significant predictor for residual lesion.

Efficacy of cisplatin in early stage cervical cancer with a long waiting period for surgery.

This study was undertaken as a prospective trial to evaluate the efficacy and safety of pre-operative cisplatin for controlling the tumor volume of stage IB-IIA cervical cancer patients whose schedule for radical surgery was longer than 3 weeks. Between June 2004 and July 2005, 42 patients were recruited to enter the study. Seventy-five mg/m(2) of cisplatin was administered for 1-2 courses. Cervical tumor volume was measured 1 day before chemotherapy and 1 day before the operation by using 3-dimensional ultrasound. Reduction of cervical tumor volume was noted in 76.2%of cases. The clinical stage, gross appearance of the tumor, histology and number of chemotherapy courses did not significantly affect chemo-responsiveness. The incidence of lymph node metastases was 16.3%. One patient experienced severe vomiting which could be controlled by ondansetron antiemetic. No severe hematologic or other non-hematologic toxicities were identified. In conclusion cisplatin is effective and safe for administration in a pre-operative setting for early stage cervical cancer patients whose surgical schedule is delayed more than 3 weeks.

Benefit of electrocardiography during front-line combination paclitaxel and carboplatin chemotherapy for epithelial ovarian cancer.

OBJECTIVE: To evaluate the patterns of electrocardiography (ECG), cardiac risk factors and its clinical consequence in women with epithelial ovarian cancer (EOC) who received paclitaxel and carboplatin (PC) as front line chemotherapy. MATERIAL AND METHOD: The medical records and electrocardiographic data of women with EOC who received paclitaxel (175 mg/min2) and carboplatin (AUC=5) every 3 weeks at Chiang Mai University Hospital between January 2000 and December 2004 were reviewed for cardiac risk factors and clinical consequence. RESULTS: Among 79 women receiving PC for EOC, 43 (54.4%) had cardiac risk factors. Seventy (88.6%) women had normal ECG, the remaining nine had sinus tachycardia (5), bundle branch block (2), mild T inversion (1), and Wolff-Parkinson-White syndrome (1) before the first course of chemotherapy. Among 70 women with normal initial ECG 8 (11.4%) had sinus tachycardia, one (1.4%) had early depolarization, two (2.9%) had sinus bradycardia and three (4.3%) had sinus arrhythmia in subsequent ECG All these cardiac disturbances were asymptomatic and needed no intervention, indicating grade I toxicity. The odds ratio of developing abnormal ECG in women with cardiac risk factor was 1.24 (95% CI = 0.33 to 4.64, p = 0.77). Among nine patients with abnormal ECG before the first course of PC, six (66.7%) had subsequent abnormal ECG but all were asymptomatic and no worsening of abnormal ECG pattern was noted. CONCLUSION: Although paclitaxel and carboplatin chemotherapy could induce abnormal ECG in women with either normal or abnormal prior ECG, its consequence was of no clinical significance. Therefore, the benefit of ECG before each treatment course was theoretically limited.

Limited value of vaginal cytology in detecting recurrent disease after radical hysterectomy for early stage cervical carcinoma.

The objective of this study was to evaluate the value of vaginal cytology in routine surveillance for recurrent cervical cancer after surgery. We reviewed the medical records of 565 patients with stage IB-IIA cervical cancer who were treated with radical hysterectomy and pelvic lymphadenectomy (RHPL) and attended follow- up at Chiang Mai University Hospital between January 2000 and May 2006. With the median follow-up of 35 months (range 1-76 months), 23 (4%) patients developed recurrence. The interval from surgery to detection of recurrence ranged from 5-61 months with a median of 23 months. Of the total 4,376 vaginal smears, 5 (0.1%) showed abnormal cytology but only 1 had malignant cells and tumor recurrence. The sensitivity and specificity of vaginal cytology for detection of recurrence were 4.3% and 99.3%, respectively. In conclusion, vaginal cytology has limited value in detection of recurrence after RHPL for early-stage cervical cancer.

Clinical outcomes and prognostic factors of node-negative cervical cancer patients with deep stromal invasion or lymphovascular space involvement following radical hysterectomy.

OBJECTIVE: To evaluate the clinical outcomes and prognostic factors of node-negative cervical cancer patients who had deep stromal invasion (DSI) and/or lymphovascular space invasion (LVSI) following radical hysterectomy and pelvic lymphadenectomy (RHPL). MATERIAL AND METHOD: The medical records of 150 node-negative stage IA2-IIA cervical cancer patients who had DSI and/or LVSI after RHPL from 1999 to 2004 were reviewed. RESULTS: Eighty-eight (58.4%) patients were treated with RHPL alone. Twenty-eight (18.7%), 23 (15.4%), eight (5.3%), and three (2%) patients received postoperative chemotherapy, chemoradiation, radiotherapy, and brachytherapy, respectively. Overall, 11 (7.3%) patients developed recurrence. The estimated 5-year disease-free survival of the patients was 90.9%. By multivariate analysis, two factors, age of less than 35 years old and a non squamous histology, were significantly independent prognostic. Eight (5.3%) patients experienced treatment-related complications. CONCLUSION: Node-negative cervical cancer patients with DSI and/or LVSI had excellent clinical outcomes. Young age and non-squamous histology are significant independent prognostic factors.

Northern Thai women with high grade squamous intraepithelial lesion on cervical cytology have high prevalence of underlying invasive carcinoma.

The aim of this study was to determine the underlying pathology of women with high grade squamous intraepithelial lesion (HSIL) on cervical cytology. A total of 681 women with HSIL cytology undergoing colposcopic examination at Chiang Mai University Hospital (CMUH) between January 2000 and December 2005 were evaluated for the underlying cervical pathology. The final pathology was diagnosed from the most severe lesions obtained by punch biopsy, loop electrosurgical procedure, cold knife conization or hysterectomy. Underlying high grade cervical lesions including cervical intraepithelial neoplasia grade 2, 3 and adenocarcinoma in situ were noted in 502 (73.7%) women. Invasive cervical carcinoma was identified in 141 (20.7%). The remaining 38 (5.6%) had either low grade or no intraepithelial lesions. No significant difference in the prevalence of underlying high grade and invasive lesions was noted between women with cytologic diagnosis of HSIL from CMUH and other hospitals. In conclusion, northern Thai women with HSIL cytology are at significant risk of having underlying severe cervical lesions, and especially invasive carcinoma which is detected in approximately one-fifth of the cases.

Histopathological outcomes of women with squamous cell carcinoma on cervical cytology.

The aim of this study was to determine the final histopathological outcome for women with a squamous cell carcinoma (SCCA) diagnosed by cervical cytology. The medical records and computerized colposcopic database of patients with SCCA on cytology who underwent colposcopy at Chiang Mai University Hospital between February 2003 and December 2005 were reviewed and 48 women with SCCA cytology were identified (mean age 50 years, range 31-73). Nineteen (39.6%) women were postmenopausal. Unsatisfactory colposcopy was noted in 42 (87.5%). Thirty one (64.6%) of the patients had a final pathological diagnosis of high-grade squamous intraepithelial lesions (HGSIL), whereas only 16 (33.3%) had invasive cancer. The remaining one patient had a low-grade squamous intraepithelial lesion. Sensitivity and specificity of colposcopic examination for predicting invasive cancer was 50% and 78%, respectively. In conclusion, most women with a SCCA on cervical cytology have high-grade cervical lesions on final pathology, with only one third demonstrating invasive cancer. The loop electrosurgical excision procedure (LEEP) remains an important measure for combined treatment and diagnosis.

Clinicopathologic analysis of women with synchronous primary carcinomas of the endometrium and ovary: 10- year experience from Chiang Mai University Hospital.

The aim of this study was to analyze the clinicopathologic features and survival outcomes of women with synchronous primary carcinomas of the endometrium and ovary that were treated at Chiang Mai University Hospital between January 1995 and December 2004. During the study period, 43 women with such tumors were identified. These carcinomas accounted for 0.58% (95%CI=0.42-0.79%) of all gynecologic malignancies. Median age at diagnosis was 49 years (range: 34-60 years). Median body mass index (BMI) was 21.6 kg/m2(range: 15.5-27.7 kg/m(2)). The majority of women (65%) were premenopausal. The most common presenting symptom was abnormal uterine bleeding (42%), followed by a pelvic mass (30%). Twenty-seven (62.8%, 95%CI= 46.7-77.0%) women had concordant endometrioid carcinomas of the endometrium and ovary. Five (11.6%) women experienced tumor recurrence with median follow up 39 months (range: 1-85 months). The overall 5-year survival was 85.2%. There was no significant difference in survival outcomes among the women who had endometrioid/endometrioid histology and those who had other histological subtypes (P=0.674). In conclusion, synchronous primary carcinomas of the endometrium and ovary, although uncommon, should be considered in differential diagnosis in premenopausal women presenting with abnormal uterine bleeding and ovarian tumors. The prognosis of patients with these tumors appears excellent.

Weekly versus three-weekly cisplatin as an adjunct to radiation therapy in high-risk stage I-IIA cervical cancer after surgery: a randomized comparison of treatment compliance.

OBJECTIVES: To compare weekly and three-weekly cisplatin as an adjunct to radiation therapy in high-risk early-stage cervical cancer after surgery with regard to treatment compliance. MATERIAL AND METHOD: From June 1st, 2003 to February 29th, 2004, the authors performed a randomized trial of radiotherapy in combination with two concurrent chemotherapy regimens - weekly or three-weekly cisplatin--in patients with high-risk cervical cancer FIGO stage I-IIA after surgery. Women with primary invasive squamous-cell carcinoma, adenocarcinoma, or adenosquamous carcinoma of the cervix were enrolled. The patients also had to have an absolute neutrophil count of at least 1,500 cells per cubic millimeter, a platelet count of at least 75,000 cells per cubic millimeter, a creatinine clearance higher than 40 milliliter per minute, and adequate hepatic function. All patients received external-beam radiotherapy according to a strict protocol. Patients were randomly assigned to receive one of two chemotherapy regimens: 75 mg per square meter of cisplatin on days 1, 22, 43 and 64 or every three weeks for 4 cycles (group 1) or 40 mg per square meter of cisplatin per week for six cycles (group 2). RESULTS: The analysis included 40 women. The first group that received three-weekly cisplatin had a higher rate of incomplete and delayed treatments than the second group that received weekly cisplatin (p < 0.001 and p = 0.0236 respectively). The relative risks of delayed courses were 2.06 (95 percent confidence interval, 1.15 to 3.68) for group 1, compared with group 2. The toxicity-related incomplete treatments rate and G-CSF doses used were significantly higher in group 1 than in group 2. CONCLUSION: Concurrent chemoradiation with weekly cisplatin regimen has more complete treatment rate and less delayed courses than that with three- weekly cisplatin among women with high-risk cervical cancer after surgery.

Concurrent cisplatin-based chemoradiation and adjuvant hysterectomy for bulky stage IB-IIA cervical cancer.

OBJECTIVES: To evaluate the outcomes and adverse effects of concurrent cisplatin-based chemoradiation and adjuvant hysterectomy for bulky stage IB-IIA cervical cancer MATERIAL AND METHOD: All eligible, thirty-four patients with bulky stage IB-IIA cervical cancer were assigned to receive weekly cisplatin 40 mg/m2 for 6 cycles concurrently with radiation followed by extrafascial hysterectomy 6 weeks after completion of radiation. RESULTS: Estimated 5-year progression-free and disease-free survival rates of 80% were observed after a median follow-up of 42 months. The overall recurrent rate was 18%. Grade 3 neutropenia and anemia were noted in only 5.9% and 2.9%, respectively. All acute toxicities were transient and were manageable. There were no treatment-related deaths or late toxicities. CONCLUSION: For appropriately selected patients with bulky stage IB-IIA cervical cancer, concurrent cisplatin-based chemoradiation followed by adjuvant hysterectomy offers an effective treatment option with acceptable toxicity.

Primary carcinoma of the fallopian tube: A clinicopathologic analysis of 27 patients.

OBJECTIVES: To analyze the clinicopathologic features of women with primary fallopian tube carcinoma DESIGN: Descriptive cross sectional study MATERIAL AND METHOD: Twenty-eight women diagnosed with primary fallopian tube carcinoma treated at Chiang Mai University Hospital between January 1997 and December 2004. RESULTS: During the study period, the primary fallopian tube carcinoma accounted for 0.48% of all gynecologic malignancies. Of the 28 patients, one was excluded for unavailable medical records. Mean age at diagnosis was 53 years (range, 38-76 years). Seventeen (63.0%) were menopausal women. The most common clinical presentation was pelvic mass (55%), followed by abnormal vaginal bleeding (18.5%). Hydrops tubae profluens was present in three (11.1%) women. The rare presenting symptoms included pelvic peritonitis and abnormal glandular cells on cervicovaginal smear were noted in one (3.7%) woman of each category. In all women, primary fallopian tube carcinoma could not be diagnosed preoperatively. During the operation, an abnormal tubal lesion was suspected in only eleven (40.7%) women. Histology were serous adenocarcinoma (70.4%), endometrioid adenocarcinoma (22.2%), undifferentiated adenocarcinoma (3.77%) and carcinosarcoma (3.7%). As opposed to epithelial ovarian cancer, the majority of women in the present study were in the early stages of the disease. CONCLUSION: Primary fallopian tube carcinoma is a rare gynecologic malignancy that has various and nonspecific presentations. Definite diagnosis is usually made postoperatively. This malignancy should be considered in differential diagnosis of peri- and postmenopausal women who present with complex adnexal mass, unexplained uterine bleeding, abnormal glandular cells on cervicovaginal smear and complicated pelvic inflammatory disease.

Radical surgery for T1 and T2 squamous cell carcinoma of the vulva through separate incisions.

OBJECTIVES: The aim of the study was to retrospectively evaluate treatment results in patients with T1 and T2 vulvar carcinoma. MATERIAL AND METHOD: The medical records of 46 patients with T1 and T2 SCC of the vulva undergoing radical excision of the tumor and groin node dissection at Chiang Mai University Hospital between January 1998 and December 2004 were reviewed. The tumor size, histologic grade, nodal status, lymph-vascular space invasion, lesion location, surgical marginal status, complications, recurrence and survival were analyzed. RESULTS: Mean age of the 46 patients (T1 = 15, T2 = 31) was 59 years with a range of 34-84 years. The incidence of lymph node metastases for T1 lesions was 13% compared to 35% for T2 lesions. Twenty nine patients (63%) experienced surgical complications, the most common one was lymphedema (16) while wound breakdown was noted in only 1 patient. With a median follow-up of 15 months, 14 patients (30%) developed recurrence, 3 (20%) and 11 (35%) in patients with T1 and T2 lesions respectively. The overall 5-year disease-free survival and 5-year survival were 37% and 40%, respectively. The 5-year survival of patients with T1 lesion was significantly higher than that of patients with T2 lesion (64% vs 31%, P = 0.04). Patients with negative nodes had significantly better survival than those with positive nodes (56% vs 18%, P = 0.02). In multivariable analysis, only the status of groin node remained as independent prognostic factors for survival. CONCLUSION: Radical excision and groin node dissection through separate incision for T1 and T2 squamous cell carcinoma of the vulva in this study has a less favorable survival outcome compared with the literature.

Extent of lymphovascular space invasion and risk of pelvic lymph node metastases in stage IB1 cervical cancer.

OBJECTIVE: To evaluate whether the extent of lymphovascular space invasion (LVSI) is a risk factor for pelvic lymph node metastases in stage IBI cervical cancer. MATERIAL AND METHOD: The clinicopathological data of 397 patients with stage IB1 cervical cancer undergoing radical hysterectomy and pelvic lymphadenectomy (RHPL) at Chiang Mai University Hospital between January 1998 and December 2002 were analyzed. The histology, tumor grade, depth of stromal invasion, uterine corpus involvement, parametrial invasion and LVSI were analyzed for their association with pelvic node metastases. The extent of LVSI was classified as negative, minimal (< 10 LVSI/cervical specimen), and extensive (> or = 10 LVSI/cervical specimen). RESULTS: Of the 397 patients, 146 (36.8%) had tumors containing LVSI, 82 (20.7%) and 64 (16.1%) had minimal and extensive LVSI, respectively. Fifty nine (14.9%) patients had pelvic node metastases. Using multivariable analysis, LVSI (p < 0.001), depth of stromal invasion (p < 0.001), tumor grade (p < 0.001), and parametrial invasion (p < 0.001) were significant predictors of pelvic node metastases. The extent of LVSI either minimal or extensive degree significantly influenced pelvic node metastases. CONCLUSION: The presence of LVSI especially extensive involvement was significantly associated with the risk of pelvic node metastases in stage IB1 cervical cancer.

Treatment results of methotrexate and folinic acid as primary chemotherapy for nonmetastatic gestational trophoblastic neoplasia.

OBJECTIVE: To evaluate the efficacy and toxicity of methotrexate and folinic acid (MTX-FA) chemotherapy in patients with nonmetastatic gestational trophoblastic neoplasia (NMGTN). MATERIAL AND METHOD: Between 1997 and 2003, a total of 67 patients with NMGTN received treatment at the Chiang Mai University Hospital. Of the 67 patients, 55 were initially treated with methotrexate 1.0 mg/kg intramuscularly (IM) on day 1, 3,5, and 7 and folinic acid 0.1 mg/kg IM on day 2, 4, 6 and 8. Treatment courses were repeated every 14 days. Clinical characteristics and outcomes were analyzed RESULTS: All 55 patients with NMGTN were cured. Of the 55 patients initially treated with MTX-FA, 49 (89%) achieved complete remission. Six (11%) patients developed methotrexate resistance, 3 were cured with actinomycin D, 1 were cured with 5-fluorouracil followed by etoposide, 2 required hystertectomy to attain remission. No serious toxicity was noted CONCLUSION: Methotrexate and folinic acid chemotherapy is highly effective and well-tolerated in treating patients with nonmetastatic gestational trophoblastic neoplasia.