The changing role of thoracotomy in gestational trophoblastic neoplasia at the New England Trophoblastic Disease Center

Evelyn L. Fleming, Leslie Garrett, Whitfield B. Growdon, Michael Callahan, Nicole S. Nevadunsky, Sue Ghosh, Donald P. Goldstein, Ross S. Berkowitz

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Objective: To review our experience with thoracotomy in gestational trophoblastic neoplasia (GTN). Study design: Nineteen thomcotomy patients from our database were identified. Thoracotomy was performed for therapeutic reasons in 11 patients and to clarify the diagnosis in eight. RESULTS: Among the 11 patients with chemotherapy-resistant pulmonary tumors, 10 of 11 (90.9%) achieved remission with thoracotomy. Thoracotomy was more likely to be done to clarify diagnosis before 1980 (83%) than after 1980 (23%) (p = 0.04), when it became more likely to be done for therapeutic indications. Ten patients had solitary lung lesions and 9 had multiple lesions. Four patients died (21%), with an average survival after thoracotomy of 149 days; patients had bilateral or multiple lung lesions, median preoperative hCG was 58,000 mIU/mL and all were stage IV. Survivors had lower stage disease, were more likely to have solitary lesions and had lower preoperative hCG levels. Conclusion: There have been several temporal changes in the indications for thoracotomy for GTN. In general, the optimal patient to achieve remission with thoracotomy will have stage III disease, a preoperative hCG of < 1,500 mIU/mL, and a solitary lung nodule resistant to chemotherapy. Likelihood of remission after thoracotomy is high in prop-erly selected patients.

Original languageEnglish (US)
Pages (from-to)493-498
Number of pages6
JournalJournal of Reproductive Medicine for the Obstetrician and Gynecologist
Volume53
Issue number7
StatePublished - Jul 2008
Externally publishedYes

Fingerprint

Gestational Trophoblastic Disease
New England
Thoracotomy
Lung
Drug Therapy
Survivors
Databases
Survival

Keywords

  • Gestational trophoblastic neoplasms
  • Thoracotomy

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Reproductive Medicine

Cite this

The changing role of thoracotomy in gestational trophoblastic neoplasia at the New England Trophoblastic Disease Center. / Fleming, Evelyn L.; Garrett, Leslie; Growdon, Whitfield B.; Callahan, Michael; Nevadunsky, Nicole S.; Ghosh, Sue; Goldstein, Donald P.; Berkowitz, Ross S.

In: Journal of Reproductive Medicine for the Obstetrician and Gynecologist, Vol. 53, No. 7, 07.2008, p. 493-498.

Research output: Contribution to journalArticle

Fleming, Evelyn L. ; Garrett, Leslie ; Growdon, Whitfield B. ; Callahan, Michael ; Nevadunsky, Nicole S. ; Ghosh, Sue ; Goldstein, Donald P. ; Berkowitz, Ross S. / The changing role of thoracotomy in gestational trophoblastic neoplasia at the New England Trophoblastic Disease Center. In: Journal of Reproductive Medicine for the Obstetrician and Gynecologist. 2008 ; Vol. 53, No. 7. pp. 493-498.
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abstract = "Objective: To review our experience with thoracotomy in gestational trophoblastic neoplasia (GTN). Study design: Nineteen thomcotomy patients from our database were identified. Thoracotomy was performed for therapeutic reasons in 11 patients and to clarify the diagnosis in eight. RESULTS: Among the 11 patients with chemotherapy-resistant pulmonary tumors, 10 of 11 (90.9{\%}) achieved remission with thoracotomy. Thoracotomy was more likely to be done to clarify diagnosis before 1980 (83{\%}) than after 1980 (23{\%}) (p = 0.04), when it became more likely to be done for therapeutic indications. Ten patients had solitary lung lesions and 9 had multiple lesions. Four patients died (21{\%}), with an average survival after thoracotomy of 149 days; patients had bilateral or multiple lung lesions, median preoperative hCG was 58,000 mIU/mL and all were stage IV. Survivors had lower stage disease, were more likely to have solitary lesions and had lower preoperative hCG levels. Conclusion: There have been several temporal changes in the indications for thoracotomy for GTN. In general, the optimal patient to achieve remission with thoracotomy will have stage III disease, a preoperative hCG of < 1,500 mIU/mL, and a solitary lung nodule resistant to chemotherapy. Likelihood of remission after thoracotomy is high in prop-erly selected patients.",
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