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| LETTER TO THE EDITOR |
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| Year : 2021 | Volume
: 4
| Issue : 4 | Page : 786-787 |
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Gestational trophoblastic neoplasia: A road less travelled
Anuj Gupta, Akhil Kapoor
Departement of Medical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Hospital and Homi Bhabha Cancer Hospital, Tata Memorial Centre, Varanasi, Uttar Pradesh, India
| Date of Submission | 11-Nov-2021 |
| Date of Decision | 21-Nov-2021 |
| Date of Acceptance | 24-Nov-2021 |
| Date of Web Publication | 29-Dec-2021 |
Correspondence Address:
Anuj Gupta
Department of Medical Oncology, MPMMCC, Sunderpur, Varanasi 221005, Uttar Pradesh
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/crst.crst_278_21
How to cite this article:
Gupta A, Kapoor A. Gestational trophoblastic neoplasia: A road less travelled. Cancer Res Stat Treat 2021;4:786-7 |
We read with great interest the article by Ghosh et al., published in the last issue of Cancer Research, Statistics, and Treatment.[1] Gestational trophoblastic neoplasia (GTN) is not very commonly encountered in oncology clinical practice. A few retrospective studies have been reported from other parts of the world.[2],[3],[4] Similar data were published by Ghosh et al., who presented their experience and outcomes among patients with GTN from the eastern part of India.[2] Their dataset included patients from 2011 to 2019. Despite a small sample size of only 24 patients, the present study is important as it provides real-world data from India.
The authors state that none of the patients underwent any surgical intervention at their center; however, few patients were operated on outside and referred to their hospital for further management. It is desirable to get more details of the surgery done on these patients (whether it was a total hysterectomy or some sort of fertility-preventing surgery). As we know, hysterectomy is usually not required for the management of GTN, but it is commonly performed in community practice. This is detrimental to the patients as these are usually young women who have not yet completed their families. In addition, the fertility outcomes of patients who did not undergo hysterectomy should be reported, as many patients may plan a pregnancy after cure.
Ghosh et al. reported higher beta-human chorionic gonadotropin (β-hCG) levels in their set of patients compared to other retrospective studies from India. It is important to realize that β-hCG levels can be accurately measured only within the analytic range of 1.8–1000 mIU/mL. However, in choriocarcinoma, the analyte level in patient samples usually exceeds the assay range of 1000 mIU/mL at presentation. In such cases, the assay should be re-run using a diluted sample to determine the actual β-hCG concentration. Sample dilution is important, and variations in results may occur due to improper dilution.[5]
Further, the authors have not reported the toxicity details, which is a common drawback associated with retrospective data analysis. The average number of chemotherapy cycles required for β-hCG levels to plateau or for complete normalization is also important and should be reported. The authors could also have reported the radiological response in patients and its correlation with β-hCG levels. It is important to note that lung nodules can persist even after achieving serologic cure following effective chemotherapy, without affecting the prognosis.[6] We request the authors to please comment on this.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Ghosh J, Dey S, Mandal D, Ganguly S, Biswas B, Dabkara D, et al. Clinicopathological features and outcomes of choriocarcinoma: A retrospective analysis from an Indian tertiary cancer center. Cancer Res Stat Treat 2021;4:486-91.  [Full text] |
| 2. | Bafna UD, Ahuja VK, Umadevi K, Srinivasan N, Mani K, Vallikad E. Gestational trophoblastic tumors – Situation analysis in a third world regional cancer center. Int J Gynecol Cancer 1997;7:197204. |
| 3. | Gulia S, Bajpai J, Gupta S, Maheshwari A, Deodhar K, Kerkar RA, et al. Outcome of gestational trophoblastic neoplasia: Experience from a tertiary cancer centre in India. Clin Oncol (R Coll Radiol) 2014;26:39-44. |
| 4. | Hussain A, Aziz SA, Bhatt GM, Lone AR, Hussain HI, Wani B, et al. Gestational trophoblastic neoplasia: Experience from a tertiary care center of India. J Obstet Gynaecol India 2016;66:404-8. |
| 5. | Sturgeon CM, McAllister EJ. Analysis of hCG: Clinical applications and assay requirements. Ann Clin Biochem 1998;35:460-91. |
| 6. | Powles T, Savage P, Short D, Young A, Pappin C, Seckl MJ. Residual lung lesions after completion of chemotherapy for gestational trophoblastic neoplasia: Should we operate? Br J Cancer 2006;94:51-4. |
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