REGRESSION CURVES OF β-HUMAN CHORIONIC SERUM GONADOTROPIN IN LOW RISK GESTATIONAL TROPHOBLASTIC NEOPLASIA PATIENTS WHO TREATED WITH SINGLE

METHOTREXATE CHEMOTHERAPY AT RSUP. H. ADAM MALIK MEDAN

Sarah Dina, Deri Edianto, Hotma P Pasaribu, Edy Ardiansyah, Iman Helmi Effendi, Juhriyani M Lubis

Department of Obstetrics and GynecologySchool of Medicine Universitas Sumatera Utara

Medan, Indonesia

Objective: To determine the regression curve of β-hCG serum patients with low-risk gestational trophoblastic neoplasia who treated with single methotrexate chemotherapy at RSUP. H. Adam Malik Medan.

Design:This study is a descriptive research with case series design.

Materials and Methods: The complete medical records of all the low risk gestational trophoblastic neoplasia patients who received a single methotrexate chemotherapy registered at RSUP. H. Adam Malik Medan between January 2010 and December 2014 were reviewed. We exclude the medical record’s of inobidienced patients. We record the number of chemotherapy cycles and the level of β-hCG serum before and after every cycle of chemotherapy from complete remission and resistance groups. The level of β-hCG serum described on the curve and analyzed descriptively.

Results: We achieved 34 patient’s medical record with 12 drop out

Picture 1. β-hCG regression curve of complete remission of low risk gestational trophoblastic neoplasia who treated with single methotrexate chemotherapy, described in 2.5 , 50 dan 97.5 percentile.

0 1 2 3 4 5 6 7 8 9 10 11 121.00

10.00

100.00

1,000.00

10,000.00

100,000.00

1,000,000.00

2.5th percentile50th percentile97.5th percentilenormal value of β-hCG (upper limit)

2.5% of patients had normal value of β-hCG after 2nd cycle of methotrexate administration, 50% of patients had normal value of β-hCG after 4th cycle of methotrexate administration and 97.5% of patients had normal value of β-hCG after 10th cycle of methotrexate administration. There are variations of β-hCG regression in the 50th percentile group, where there is an increase of β-hCG after normal value in 8th cycle and decrease in 9th cycle to normal.

Picture 2. β-hCG regression curve of complete remission group of low risk gestational trophoblastic neoplasia who treated with single methotrexate chemotherapy, combine with β-hCG curve’s of MTX resistance group.

0 1 2 3 4 5 6 7 8 9 10 11 121.00

10.00

100.00

1,000.00

10,000.00

100,000.00

1,000,000.00

2.5th percentile50th percentile97.5th percentileMTX resistance patient 1MTX resistance patient 2MTX resistance patient 3MTX resistance patient 4MTX resistance patient 5MTX resistance patient 6MTX resistance patient 7normal value of β-hCG (upper limit)

Before starting chemotherapy, 2 patients of the 7 patients of MTX-resistant group (28.5%) are above the 97.5th percentile of complete remission group. Before the 2nd cycle, 3 patients (42.8%) of the 7 patients are above 9.75th percentile. Before the 4th cycle, 5 patients (100%) of 5 patients who were still undergoing chemotherapy until the end of the cycle are above the 97.5th percentile.

Conclusion:

1. 97.5% of patients in complete remission group reached normal value at 10th cycle.2. MTX resistant group had β-hCG serum level higher than complete remission group before

chemotherapy.3. β-hCG regression curve of complete remission group had decreased value β-hCG faster

than MTX resistant group curve.