Department of Obstetrics and Gynecology (Honorary Professor), Tottori University Medical School, Yonago, Japan
Received date: October 22, 2013; Accepted date: October 23, 2013; Published date: October 28, 2013
Citation: Maeda K (2014) Prophylactic MTX Therapy to Prevent Choriocarcinoma. J Health Med Informat 5:e113. doi: 10.4172/2157-7420.1000e113
Copyright: © 2014 Maeda K. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Choriocarcinoma is the very malignant tumor in gynecology characterized tumor metastases to whole organs and tissues, where the patientdied mainlydue to the brain metastasis. It developed after the evacuation of total hydatidi form mole, where no fetus was present, but the uterus was filled with cystic molar tissue, which was covered by abnormal trophoblasts, and its presence was confirmed by human chorionic gonadotraopine (HCG) in the blood and urine, and recently by ultrasonic image. A uterine choriocarcinoma is diagnosed by hemorrhage, enlarged uterus, ultrasound and the high HCG (usually beta HCG) in the blood and urine, and confirmed by histologic examination that the tumor was composed purely by trophoblasts but no molar villus pattern. In old times before 1960, the treatment was hysterectomy, which was followed by a pulmonary metastasis after one year and hematologically spread to whole body. The disease was frequent in East Asia old times. Maeda studied the trophoblastic diseases including choriocarcinoma , which was not a local malignancy but a systemic disease, and treated the metastases by Methotrexate (MTX), which was the most sensitive by choriocarcinoma, and achieved the disappearance of metastasis . Afterwards, the systemic MTX was administered before the hysterectomy (primary chemotherapy), where not only the metastasis but also primary uterine focus disappeared, if the drug was administered until the HCG disappeared in the blood and urine. The primary chemotherapy was effective to maintain the fertility of the patient; actually a case was normally pregnant after the primary chemotherapy. That was the first success of drug therapy of malignant neoplasia preserving fertility.
We intended to prevent the postmolar development of choriocarcinoma by prophylactic chemotherapy with MTX, after confirmation of the primary chemotherapy with MTX in 1960s at the Department of Obstetrics and Gynecology, Kyushu University, Fukuoka Japan .
The prophylactic chemotherapy was started as early as after the evacuation of total hydatidi form mole in 108 cases. The MTX was orally administered for 10mg a day for 7 days, 70 mg in total in typical cases. Two prolonged positive pregnancy test cases after molar evacuation were given 230 and 340 mg MTX in total until the urinary HCG was negative by the biological Friedman’s rabbit’s ovulation tests. The control were 81 cases composed of 42 cases of no chemotherapy and 39 cases received chemotherapy other than MTX.
No choriocarcinoma developed in 108 MTX treated cases, while 6 choriocarcinoma (7.4%) developed in 81 control cases. Significant difference (p=0.004) was noted between MTX and control groups in the development of choriocarcinoma.
The invasive mole was found in 2 (1.9%) in 108 MTX group and 2 (2.5%) in the control, where insignificant difference (p=0.77) was noted between two groups. It is natural, because molar tissue invaded the myometrium before the molar evacuation, and the outcome of invasive mole is benign after the hysterectomy.
Therefore, the prevention of malignant choriocarcinoma was successful by the MTX treatment in postmolar state. As the result, the development of choriocarcinoma is rare in Japan after the establishment of postmolar prophylactic chemotherapy. Another reasonwill be the early detection and removal of hydatidi form mole before trophoblastic invasion to the endometriumby the ultrasound imaging of early pregnancy in the first trimester.
Side effects of prophylactic MTX administration were shown, where no life threatening heavy toxicity was found (Table 1).
|Toxic signs||No. of the sign|
|Vomiting or nausea||29|
|No toxicity in 23 cases|
Table 1: Systemic toxicity of MTX in the prophylactic chemotherapy.