Response to Initial Treatment of Low and Intermediate Risk Gestational Trophoblastic Disease with Methotrexate and Folinic Acid
Monnapa Tonanont, MD*, Peerapong Inthasorn, MD*, Dittakan Boriboonhirunsarn, MD*, Weerasak Wongthiraporn, MD*, Issaracha Suphanit, BSc, MT*
Affiliation : * Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University
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).
Materials and Methods : 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 < 5 mIU/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. Com-
plete 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 < 10,000 mIU/ml and stage I disease.
Conclusion : Methotrexate with folinic acid is effective treatment for low and intermediate risk GTD with
minimal severe toxicity.
Keywords : Gestational trophoblastic disease, Methotrexate with folinic acid, Response, Toxicity
