Poor-prognosis gestational trophoblastic disease: an update.

Ten patients with poor-prognosis gestational trophoblastic neoplasia were treated from 1979 to 1983 primarily with the modified Bagshawe chemotherapy regimen. Four patients were noted to have brain metastases, and one patient had liver metastases. In addition, etoposide (VP-16) was used in seven patients, bleomycin in six, cisplatin in five, 5-fluorouracil in two, and cis-retinoic acid in four patients. Thoracotomy, hysterectomy, and splenectomy were performed after chemotherapy was initiated for isolated resistant disease. At present, nine of the ten patients (90%) are in complete remission for four to 44 months. Significant myelosuppression was encountered in seven patients and life-threatening toxicity was noted in two patients. Currently, poor-prognosis patients are treated with the modified Bagshawe regimen, alternating every other week with etoposide, bleomycin, and cisplatin.