Comparison of the Treatment Outcomes of Methotrexate and Adriamycin D in the Treatment of Low Risk Gestational Trophoblastic Disease at the Kenyatta National Hospital

Abstract

Introduction: Gestational Trophoblastic Disease explains an infrequent and heavily treatable cohort of growths that are caused by placental tissue and by an abnormal conception resulting from abnormal fertilization. The management of these disorders as per the world health organization entails risk scoring; low risk gestational neoplasms (LRGTNs) have been managed using single chemotherapeutic agents with variable outcome. The treatment protocol and outcomes however depend on institutional experience with lack of consensus about the most appropriate treatment regimen. Objective: To determine the treatment outcomes and side effects of using methotrexate in comparison to Actinomycin D in the management of patient with low-Risk Gestational Trophoblastic Neoplasms at the Kenyatta National Hospital Methodology: The study was a retrospective cohort study comparing the treatment outcomes for methotrexate and Actinomycin D among patient with low risk gestational neoplasm. A sample of 105 records (70 for methotrexate and 35 on Actinomycin D) was included in the study. Following Ethical approval, data was extracted from the patient records and uploaded to the SPSS version 23 software for cleaning and coding before analysis. Characteristics of the patient and the disease, such as age, parity and serum human chorionic gonadotropic (HCG) levels, FIGO 2002 anatomic stage and risk scores assessed. The Pearson μ2 test was utilized in comparing and identifying possible associations between quantitative variables. In the case of continuous variables with a lop-sided distribution, the Mann Whitney test was utilized in comparing means between two independent classes. The level of significance for each test is fixed at p<0.05. Results: 11 The patients on actD regimen had significantly better average remision rate (91.4%) than those in MTX regimen (72.9%) (p=0.028). The average number of chemotherapy sessions attended by patients was comparable across both groups, 6 for the ACT-D and 7 for the MTX (P=0.140). Adjusted associations between treatment outcome and potential predictors showed that only the treatment group and the modified WHO scoring before chemotherapy were significant predictors of treatment outcomes. In our study, hair loss was more common among patients with MTX (57.1%) compared to ACT-D (37.1%), Mouth sores more in patiens on ACT-D (25.7%) compared to MTX (7.1%); The other side effects (nausea, anemia, and thrombocytopenia) were less common and similar across both groups Conclusion: Our findings add to the literature that has demonstrated that single-agent chemotherapy can be very effective in treating low-risk GTN. Compared with MTX, ACT-D may be the better option as a first-line single chemotherapy. Study utility: The outcomes of this study will be incorporated into the KNH treatment protocols for the LR GTNs management using the most effective, safest and easy to follow treatment protocol