First-line chemotherapy in low-risk gestational trophoblastic neoplasia
Gestational trophoblastic neoplasia (GTN) is a rare but curable disease. Patients are categorised into low or high risk groups using a variety of scoring systems. The majority of patients with low risk GTN respond to chemotherapy, however, occasionaly patients will die. A large number of regimens are used worldwide in the management of low risk GTN. The choice of the regimen is usually dependent on geographic location, prior training and current experience with the specific regimen. Regimens have significant differences in route of administration, hospitalisation and side effects and so have a bearing on healthcare cost. This review examined the studies, both randomised and non-randomised, that compared the available regimens. We found that bi-weekly "pulsed" dactinomycin was superior to weekly methotrexate in the reported doses. We believe further high quality randomised controlled trials are required to establish the best first line chemotherapy regimen for low risk GTN as the currently used chemotherapy regimens are based on the experience of the treating centres.