SEVERE DISEASE PROGRESSION OF POSTMOLAR GESTATIONAL NEOPLASM IN A VIETNAMESE YOUNG FEMALE PATIENT AFTER TREATMENT REFUSAL: INSIGHTS FROM A CASE REPORT AND LITERATURE REVIEW

Exp Oncol. 2024 Oct 9;46(2):154-164. doi: 10.15407/exp-oncology.2024.02.154.

Abstract

Choriocarcinoma is characterized as the most aggressive malignant alternation of gestational trophoblastic neoplasm; however, this illness is a curable malignancy. Although a rarity, this disease affects a female patient's life and causes a fatal condition. Choriocarcinoma is a life-threatening disease since it is initially insidious and can rapidly lead to masive hemorrhage, even death. Choriocarcinoma should be suspected in childbearing-age women with the high-risk scores according to FIGO. The study aims to report a severe case of widespread metastatic choriocarcinoma to optimize the treatment with multiagent chemotherapy and a multidisciplinary cooperation at our center. A G1P0 20-year-old woman was referred to the hospital for suspicion of metastatic choriocarcinoma after self-stopping chemotherapy because of the COVID-19 pandemic. During hospitalization, the tumor metastasized and presented profuse intraabdominal hemorrhage. The patient underwent immediate surgical intervention to control bleeding, and a definitive diagnosis was accurately established by the histopathological examination. After surgery, the EMA/CO regimen was administered as the first line of treatment, despite the patient being in a coma and requiring a ventilator machine. After 6 cycles of the EMA/CO regimen, her serum β-hCG level decreased to 8 mUI/mL, however, her β-hCG concentration was not down to a negative value. Thus, the patient received paclitaxel/cisplatin alternating with paclitaxel/etoposide (TP/TE regimen) for complete remission following 2 cycles. The delays in choriocarcinoma treatment are prognostic factors for worse outcomes, whereas chemotherapy may be considered a suitable treatment even in a patient's coma, thus improving a prognosis substantially.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Choriocarcinoma* / drug therapy
  • Choriocarcinoma* / pathology
  • Cisplatin / administration & dosage
  • Cisplatin / therapeutic use
  • Cyclophosphamide
  • Dactinomycin
  • Disease Progression*
  • Etoposide / administration & dosage
  • Etoposide / therapeutic use
  • Female
  • Gestational Trophoblastic Disease* / drug therapy
  • Gestational Trophoblastic Disease* / pathology
  • Humans
  • Methotrexate
  • Pregnancy
  • Southeast Asian People
  • Treatment Refusal*
  • Uterine Neoplasms* / drug therapy
  • Uterine Neoplasms* / pathology
  • Vietnam
  • Vincristine
  • Young Adult

Substances

  • Cisplatin
  • Cyclophosphamide
  • Dactinomycin
  • Etoposide
  • Methotrexate
  • Vincristine

Supplementary concepts

  • EMA-CO protocol