Gestational Trophoblastic Neoplasia: A Retrospective Study from a Tertiary Cancer Care Centre in Eastern India

Introduction: Gestational Trophoblastic Disease (GTD) represents a rare group of pregnancy-related tumours arising from the abnormal proliferation of trophoblastic tissue within the uterus. This condition is associated with elevated levels of the beta subunit of Human Chorionic Gonadotropin (β-hCG). Early diagnosis and appropriate treatment are essential due to the tumour’s high sensitivity to chemotherapy and excellent prognosis, even in metastatic cases. Aim: To evaluate the clinical presentation, treatment response, and follow-up outcomes of patients with Gestational Trophoblastic Neoplasia (GTN) treated at a tertiary cancer care centre in Eastern India. Materials and Methods: A retrospective observational study was conducted at the College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India, between January 2021 and December 2023. Twenty eight consecutive patients with histologically confirmed GTN were included. Patients were stratified into low risk (score <7, n=21) and high risk (score ≥7, n=7) categories based on the World Health Organisation (WHO) prognostic scoring system. Treatment decisions were made according to International Federation of Gynaecology and Obstetrics (FIGO) guidelines. Low risk patients received intramuscular Methotrexate (1 mg/kg on days 1, 3, 5, and 7) with leucovorin rescue, whereas high risk patients were treated with multi-agent EMACO (Etoposide, Methotrexate, Actinomycin-D, Cyclophosphamide, and Vincristine) chemotherapy. Treatment response was evaluated through weekly serum β-hCG monitoring until normalisation, followed by monthly surveillance for 12 months. Descriptive statistical analysis was performed using IBM Statistical Package for Social Sciences (SPSS) version 26. Results: Among the 28 patients analysed, the most common presenting symptom was abnormal vaginal bleeding, noted in 24 patients (85.7%), while 4 patients (14.3%) were asymptomatic. The majority were aged below 40 years (67.9%) and nulliparous (57.1%). Serum β-hCG levels at presentation varied widely, with 35.7% showing levels ≥100,000 mIU/ ml. Based on WHO scoring, 21 patients were classified as low-risk and 7 as high-risk. All low-risk patients received Methotrexate, of whom 4 required a switch to Actinomycin D due to suboptimal response. High-risk patients were treated with EMACO; 2 required escalation to EMA/EP, with one patient undergoing hysterectomy for persistent uterine disease. All patients achieved remission with no recurrence during a 12-month follow-up. Conclusion: GTN is a highly chemo-sensitive tumour with an excellent prognosis when treated promptly according to established risk stratification guidelines. Early initiation of appropriate chemotherapy regimens results in high cure rates, even in the presence of metastases, highlighting the importance of timely diagnosis and treatment.