mercaptopurine and Choriocarcinoma

Thymic carcinoma associated with acute monocyte leukemia (AMoL) and a history of choriocarcinoma was diagnosed in a 58-year-old female. We found no other such case in a literature search. She was first treated with DCMP therapy: daunorubicin, cytosine arabinoside, 6MP-riboside, and prednisolone against AMoL. After induction chemotherapy, complete AMoL remission was attained. Chest CT scan after chemotherapy revealed regression of the mediastinal tumor. Resection of the tumor included the left upper lobe of the lung, phrenic nerve and pericardium. Pathological diagnosis showed poorly or moderately differentiated squamous cell carcinoma. Although the patient died of pneumonia during chemotherapy for relapsed AMoL, chest X-ray and CT revealed no recurrence of the mediastinal tumor after the original operation. Judging from this case and other successful cases of chemotherapy, we feel that intensive chemotherapy may be a beneficial strategy against thymic carcinoma.

Topics: Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Squamous Cell; Choriocarcinoma; Combined Modality Therapy; Cytarabine; Daunorubicin; Female; Humans; Leukemia, Monocytic, Acute; Mercaptopurine; Middle Aged; Neoplasms, Multiple Primary; Prednisolone; Thymus Neoplasms; Uterine Neoplasms

Topics: Adrenal Cortex Hormones; Alkylating Agents; Animals; Antineoplastic Agents; Asparaginase; Choriocarcinoma; Dactinomycin; Female; Folic Acid Antagonists; History, 19th Century; History, 20th Century; Humans; Leukemia, Lymphoid; Lymphoma; Mercaptopurine; Neoplasms; Pregnancy

Trophoblastic tumors are among the rare diseases in this country. The most important clinical aspects are demonstrated by references and personal experiences in the treatment of trophoblastic tumors. In many countries (SU, USA, GB, Japan) the treatment of trophoblastic tumors has been centralized.--The therapeutical strategy is based on histology, stage and other important prognostic factors. Most important is chemotherapy with antineoplastic substances. Surgery and radiation are to be used only under appropriate indication. After treatment the control of the HCG-values by radioimmunassay is of high importance for the early diagnosis of relapse.--All facts demonstrate, that also in the GDR a stronger centralization of the treatment of trophoblastic tumors should be attained.

Topics: Choriocarcinoma; Chorionic Gonadotropin; Dactinomycin; Drug Therapy, Combination; Female; Humans; Mercaptopurine; Methotrexate; Neoplasm Invasiveness; Neoplasm Metastasis; Pregnancy; Prognosis; Trophoblastic Neoplasms; Uterine Neoplasms

Although cytotoxic immunosuppressive agents play an unquestionably useful role in treating many neoplastic and non-neoplastic disorders, there is accumulating evidence that the toxicity associated with their use is considerable. The therapeutic successes obtained with antitumor agents have led to increases in the life span of cancer patients, but have also provided the opportunity for this toxicity to become manifest. A search of the available literature was carried out, with emphasis on cases in which a malignancy developed in patients following chemotherapy for either neoplastic or non-neoplastic (e.g., renal transplantation, psoriasis) conditions; particular focus was given to the incidence of acute myelogenous leukemia in various groups of Hodgkin's disease and multiple myeloma patients. That patients with nonmalignant conditions treated with cytotoxic immunosuppressive agents are also at increased risk of developing a malignancy raises the possibility that these agents may have oncogenic potential. Therefore, one may be faced with the paradox that the patients benefiting most from chemotherapy may be at highest risk of suffering its consequences.

Topics: Alkylating Agents; Animals; Antineoplastic Agents; Azathioprine; Burkitt Lymphoma; Choriocarcinoma; Cyclophosphamide; Dactinomycin; Female; Hodgkin Disease; Humans; Immunosuppressive Agents; Kidney Neoplasms; Leukemia, Myeloid, Acute; Lymphoma; Mechlorethamine; Melphalan; Mercaptopurine; Methotrexate; Mice; Multiple Myeloma; Neoplasms; Prednisone; Pregnancy; Procarbazine; Time Factors; Vincristine

Topics: Chemotherapy, Cancer, Regional Perfusion; Chlorambucil; Choriocarcinoma; Chorionic Gonadotropin; Cyclophosphamide; Dactinomycin; Drug Therapy, Combination; Female; Gonadal Steroid Hormones; Humans; Hysterectomy; Mercaptopurine; Methotrexate; Neoplasm Metastasis; Ovarian Neoplasms; Postoperative Care; Pregnancy; Trophoblastic Neoplasms; Uterine Neoplasms; Vinblastine

Topics: Alkylating Agents; Aminopterin; Chlorambucil; Choriocarcinoma; Chorionic Gonadotropin; Dactinomycin; Diet; Female; Hormones, Ectopic; Humans; Hydatidiform Mole; Hydatidiform Mole, Invasive; Isoantigens; Male; Mercaptopurine; Methotrexate; Neoplasm Metastasis; Pregnancy; Socioeconomic Factors; Testicular Neoplasms; Transplantation Immunology; Trophoblastic Neoplasms; Uterine Neoplasms; Vincristine

Topics: Acute Disease; Administration, Oral; Adult; Age Factors; Body Weight; Burkitt Lymphoma; Carcinoma, Squamous Cell; Child; Choriocarcinoma; Drug Combinations; Female; Folic Acid Antagonists; Humans; Injections, Intramuscular; Injections, Intravenous; Leukemia; Mercaptopurine; Methotrexate; Prednisone; Pregnancy; Time Factors; Vincristine

Topics: Alkylating Agents; Aminopterin; Animals; Antimetabolites; Antineoplastic Agents; Busulfan; Chlorambucil; Choriocarcinoma; Colchicine; Female; Fetal Death; Folic Acid Antagonists; Gestational Age; Humans; Mercaptopurine; Methotrexate; Neoplasms; Nitrogen Mustard Compounds; Pregnancy; Pregnancy Complications; Urethane; Vinblastine

Chemotherapy may induce acute ovarian failure, but in women who retain gonadal function throughout chemotherapy, the late effects upon ovarian function are unknown. A retrospective controlled survey was performed to ascertain whether chemotherapy for gestational trophoblastic tumours (GTT) results in premature menopause. Questionnaires were sent to 1,489 women diagnosed between 1971 and 1990 with GTT, including 1089 who had received chemotherapy and 400 who had not received chemotherapy (controls). Responses were obtained from 972 chemotherapy-treated patients and 327 controls. 124 women were not evaluable for menopause date as they had undergone hysterectomy as part of the treatment for GTT or had developed permanent amenorrhoea during chemotherapy. Overall, 172 women reported that they were postmenopausal, including 157 women who had received chemotherapy. The median age at menopause for the evaluable population was 50 years (range 25-56 years). The age at menopause was significantly earlier in the treated arm (median 50, range 25-56 years) than in the controls (median 53, range 40-57 years) (logrank test chi 2 = 12.6, P = 0.0004). Menopause occurred significantly earlier in women treated with combination chemotherapy (median 49, range 25-56 years) compared with single agent methotrexate (median 51, range 25-56 years) (logrank test chi 2 = 8.3, P = 0.004). However, the age at completion of chemotherapy in the treated arm did not influence the age of menopause (proportional Hazards chi 2 = 1.99, P = 0.16). Chemotherapy for GTT induces menopause 3 years earlier than it occurs in women with GTT who do not receive chemotherapy. Although the difference is statistically significant, the magnitude is modest and most women can be reassured that neither fertility nor postmenopausal osteoporosis will be greatly affected.

Topics: Adult; Antineoplastic Agents; Choriocarcinoma; Dactinomycin; Etoposide; Female; Follow-Up Studies; Humans; Hydroxyurea; Leucovorin; Menopause, Premature; Mercaptopurine; Methotrexate; Middle Aged; Pregnancy; Retrospective Studies; Risk Factors; Trophoblastic Neoplasms

Advances in the management of gestational trophoblastic tumor have been made during the last three decades. Individualization of the therapy is one of the major advances. A number of risk factors has proved to predict accurately the prognosis of each patient. A few systems were currently in use, but difficult in putting them to practical use in the different geographical areas. At National Taiwan University Hospital from 1965 to 1979, 65 patients treated by chemotherapy were analyzed with respect of various prognostic factors. The score was assigned according to the mortality rate of each item to each prognostic factor, and thus established a scoring system which is suitable for the use in Taiwan. After establishment of our scoring system, 51 patients from 1980 to 1986 were treated according to the system and the appropriate therapeutic regimens. The outcome of these patients and toxicity of the different therapeutic regimens are presented.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Choriocarcinoma; Cyclophosphamide; Doxorubicin; Drug Evaluation; Etoposide; Female; Humans; Leucovorin; Leukopenia; Liver; Mercaptopurine; Methotrexate; Middle Aged; Pregnancy; Pregnancy Complications, Neoplastic; Prognosis; Remission Induction; Risk Factors; Taiwan; Trophoblastic Neoplasms; Uterine Neoplasms

Large dosage of 5-fluorouracil given by slow intravenous infusion has proved to be very effective in the treatment of gestational trophoblastic neoplasms. From 1965 through 1975, 5-fluorouracil was used as a single chemotherapeutic agent in 173 cases of invasive mole and 139 cases of choriocarcinoma. Complete remission was achieved in 84.9% of cases of invasive mole and in 59.3% of cases of choriocarcinoma when 5-fluorouracil was used as the initial treatment. Seven recurrences with three deaths occurred during follow-up in 216 patients who had achieved complete remission, providing a recurrence rate of 3.2% and recurrence death rate of 1.4%. All of the survivors were followed up for more than 5 years and 85.6% for more than 10 years. Toxicity of 5-fluorouracil was milder and less frequent than that of 6-mercaptopurine or methotrexate. The toxic reaction specific to 5-fluorouracil was diarrhea, which can result in pseudomembranous colitis if improperly treated. One of the two toxic deaths was due to this complication.

Topics: Choriocarcinoma; Diarrhea; Female; Fluorouracil; Follow-Up Studies; Humans; Hydatidiform Mole, Invasive; Mercaptopurine; Methotrexate; Neoplasm Recurrence, Local; Pregnancy; Uterine Neoplasms

Trophoblastic disease of pregnancy presents a continuous spectrum ranging from the non-invasive mole to the choriocarcinoma; modern chemotherapy has radically changed the prognosis of the latter. A pregnancy without mole was followed by choriocarcinoma with a high titer of chorionic gonadotrophin and vaginal, pelvic, and pulmonary metastasis, clinically apparent shortly after premature delivery. Neurologic phocality was manifested a few days before the onset of labour, and its relationship with the basic disease is discussed. A definitive cure was obtained by intermittent massive chemotherapy along with surgical resection of an isolated thyroid metastasis (a previously unreported location) and, posteriorly, of a pulmonary metastasis, both appearing during chemotherapy. The control of the therapeutic response by periodical monitoring of chorionic gonadotrophin levels is necessary in order to detect resistance to therapy and, eventually, to confirm definitive cure of the disease.

Topics: Adult; Antineoplastic Agents; Choriocarcinoma; Chorionic Gonadotropin; Cyclophosphamide; Dactinomycin; Drug Therapy, Combination; Female; Humans; Mercaptopurine; Methotrexate; Neoplasm Metastasis; Pregnancy; Pregnancy Complications; Uterine Neoplasms

Gestational trophoblastic malignancy, although rare, offers the clinician the opportunity of being able to cure a malignant disease with cytotoxic chemotherapy. Such an opportunity is fulfilled only when the progress of the post-molar patients is monitored and chemotherapy instituted as soon as the malignant transformation of the mole is documented. The management and treatment of nine cases is presented and discussed.

Topics: Adult; Choriocarcinoma; Female; Humans; Hysterectomy; Leucovorin; Mercaptopurine; Methotrexate; Pregnancy; Uterine Neoplasms

Topics: Adolescent; Adult; Black People; Brain Neoplasms; Choriocarcinoma; Female; Humans; Jamaica; Mercaptopurine; Methotrexate; Middle Aged; Neoplasm Metastasis; Pregnancy; Prognosis

Radioimmunoassays and bioassays based on the reactions of the native molecule of human chorionic gonadotropin (HCG) fail to differentiate HCG from pituitary luteinizing hormone (LH). An assay based on the beta-subunit of HCG which detects HCG exclusively has been used in our laboratory to monitor patients undergoing chemotherapy for gestational trophoblastic disease (GTD). We have been able to differentiate minimal, persisting tumor activity from normal levels of pituitary gonadotropins and have based therapy on these findings. Alternatively, treatment has been terminated when HCG is no longer detectable in the serum. Tumor activity has been detected in the beta-subunit assay at a time when biologic activity in the urine indicated remission.

Topics: Adult; Antineoplastic Agents; Biological Assay; Bleomycin; Chlorambucil; Choriocarcinoma; Chorionic Gonadotropin; Dactinomycin; Female; Follow-Up Studies; Humans; Hydatidiform Mole; Hydatidiform Mole, Invasive; Luteinizing Hormone; Mercaptopurine; Methotrexate; Monitoring, Physiologic; Neoplasm Metastasis; Pregnancy; Radioimmunoassay; Remission, Spontaneous; Trophoblastic Neoplasms

In three patients with malignant disease HBsAg was detected in the serum at least 6 months before the development of acute hepatitis type B, which in each case followed a fulminant course to death. It is suggested that suppression of the normal immunological responses to hepatitis-B viral antigens by cytotoxic drug therapy permitted widespread infection of hepatocytes. Subsequently, upon withdrawal of these drugs, recovery of immunocompetence resulted in rapid destruction of all infected hepatocytes and massive liver damage. Screening for HBsAg before cytotoxic drug therapy, careful monitoring of liver function during its withdrawal, and prompt treatment with corticosteroids should abnormalities occur may prevent this unfortunate sequence of events.

Topics: Adult; Antineoplastic Agents; Chlorambucil; Choriocarcinoma; Cyclophosphamide; Dactinomycin; Female; Hepatitis B; Hepatitis B Antigens; Humans; Immunosuppression Therapy; Leukemia; Leukemia, Lymphoid; Leukemia, Myeloid; Male; Mercaptopurine; Methotrexate; Prednisolone; Pregnancy; Substance Withdrawal Syndrome; Vincristine

Topics: Adult; Antineoplastic Agents; Choriocarcinoma; Colchicine; Dactinomycin; Daunorubicin; Female; Flavonoids; Humans; Lung Neoplasms; Melphalan; Mercaptopurine; Methotrexate; Middle Aged; Mitomycins; Neoplasm Metastasis; Olivomycins; Pneumonectomy; Pregnancy; Uterine Neoplasms; Vinblastine

Topics: Adult; Choriocarcinoma; Dactinomycin; Drug Therapy, Combination; Female; Humans; Mercaptopurine; Methotrexate; Neoplasm Metastasis; Pregnancy; Russia; Streptonigrin; Time Factors; Trophoblastic Neoplasms; Uterine Neoplasms

Topics: Adult; Choriocarcinoma; Chorionic Gonadotropin; Dactinomycin; Drug Therapy, Combination; Female; Humans; Hydatidiform Mole; Mercaptopurine; Methotrexate; Neoplasm Metastasis; Pregnancy; Remission, Spontaneous; Trophoblastic Neoplasms

Topics: Adolescent; Adult; Antineoplastic Agents; Choriocarcinoma; Cyclophosphamide; Dactinomycin; Female; Follow-Up Studies; Head and Neck Neoplasms; Hemangiosarcoma; Humans; Infant; Lung Neoplasms; Male; Mechlorethamine; Mercaptopurine; Methotrexate; Middle Aged; Neoplasm Metastasis; Pregnancy; Prostatic Neoplasms; Sarcoma; Teratoma; Testicular Neoplasms; Thoracic Neoplasms; Thyroid Neoplasms; Triaziquone; Uterine Neoplasms; Vinblastine

Topics: Adult; Angiography; Choriocarcinoma; Dactinomycin; Female; Humans; Iliac Vein; Mercaptopurine; Phlebography; Pregnancy; Pulmonary Artery; Pulmonary Embolism; Radionuclide Imaging; Uterine Neoplasms; Vena Cava, Inferior

Topics: Adult; Choriocarcinoma; Female; Humans; Hysterectomy; Lung Neoplasms; Mercaptopurine; Methotrexate; Neoplasm Metastasis; Postoperative Complications; Pregnancy

Topics: Adult; Choriocarcinoma; Female; Humans; Hydatidiform Mole; Hysterectomy; Mercaptopurine; Methotrexate; Neoplasm Metastasis; Postoperative Complications; Pregnancy; Remission, Spontaneous; Thoracic Neoplasms; Uterine Neoplasms

Topics: Adult; Blood Transfusion; Brain; Brain Neoplasms; Cerebral Angiography; Cerebrovascular Disorders; Choriocarcinoma; Dactinomycin; Encephalitis; Female; Headache; Hemiplegia; Humans; Mercaptopurine; Methotrexate; Middle Aged; Neoplasm Metastasis; Neurologic Manifestations; Pregnancy; Seizures; Uterine Neoplasms

Topics: Choriocarcinoma; Estrogens; Female; gamma-Globulins; Genital Neoplasms, Female; Humans; Mercaptopurine; Methotrexate; Pregnancy

Topics: Adolescent; Adult; Antineoplastic Agents; Choriocarcinoma; Dactinomycin; Female; Humans; Lung Neoplasms; Mercaptopurine; Methotrexate; Neoplasm Metastasis; Pregnancy

Topics: ABO Blood-Group System; Absorption; Adenocarcinoma; Antineoplastic Agents; Blood Platelets; Breast Neoplasms; Choriocarcinoma; Cyclophosphamide; Dactinomycin; Dysgerminoma; Erythrocytes; Female; Hemagglutination Tests; Humans; Immune Sera; Isoantigens; Leukemia; Leukocytes; Male; Mercaptopurine; Methotrexate; Nitrogen Mustard Compounds; Pregnancy; Uracil Mustard

Topics: Abortion, Septic; Adult; Choriocarcinoma; Diagnosis, Differential; Diagnostic Techniques, Surgical; Female; Humans; Hysterectomy; Lung Neoplasms; Mercaptopurine; Methotrexate; Neoplasm Metastasis; Pelvic Neoplasms; Pregnancy; Pregnancy Complications; Pregnancy Tests; Pregnancy, Ectopic

Topics: Adult; Castration; Choriocarcinoma; Female; gamma-Globulins; Humans; Hysterectomy; Mercaptopurine; Methotrexate; Pregnancy; Uterine Neoplasms

Topics: Adult; Choriocarcinoma; Chorionic Gonadotropin; Female; Humans; Immunoassay; Lung Neoplasms; Mercaptopurine; Methotrexate; Neoplasm Metastasis; Pregnancy; Vaginal Neoplasms

Topics: Angiography; Calcinosis; Choriocarcinoma; Female; Lung Neoplasms; Mercaptopurine; Methotrexate; Neoplasm Metastasis; Pregnancy

Topics: Antineoplastic Agents; Asparaginase; Burkitt Lymphoma; Choriocarcinoma; Cyclophosphamide; Cytarabine; Dactinomycin; Daunorubicin; Female; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Melphalan; Mercaptopurine; Methotrexate; Prednisone; Pregnancy; Vincristine; Wilms Tumor

Topics: Antineoplastic Agents; Busulfan; Carcinoma, Squamous Cell; Child; Chlorambucil; Choriocarcinoma; Dactinomycin; Female; Fluorouracil; Gonadal Steroid Hormones; Hodgkin Disease; Humans; Hydrazines; Leukemia; Lymphoma, Large B-Cell, Diffuse; Lymphoma, Non-Hodgkin; Male; Mercaptopurine; Mesenchymoma; Methotrexate; Multiple Myeloma; Nitrogen Mustard Compounds; Ovarian Neoplasms; Pregnancy; Prostatic Neoplasms; Steroids; Testicular Neoplasms; Urethane; Vinblastine; Vincristine; Wilms Tumor

Topics: Abortion, Missed; Abortion, Threatened; Adult; Choriocarcinoma; Chorionic Gonadotropin; Diagnosis, Differential; Female; Humans; Hysterectomy; Mercaptopurine; Methotrexate; Neoplasm Metastasis; Pregnancy; Uterine Neoplasms; Vaginal Neoplasms

Topics: Adult; Choriocarcinoma; Chorionic Gonadotropin; Dactinomycin; Female; Humans; Hysterectomy; Mercaptopurine; Methotrexate; Pregnancy

Topics: Adolescent; Adult; Choriocarcinoma; Female; Humans; Mercaptopurine; Methotrexate; Pregnancy

Topics: Adult; Choriocarcinoma; Chorionic Gonadotropin; Humans; Male; Mercaptopurine; Methotrexate; Neoplasm Metastasis; Teratoma; Testicular Neoplasms

Topics: Adult; Antibiotics, Antineoplastic; Antimetabolites; Chlorambucil; Choriocarcinoma; Dactinomycin; Dysgerminoma; Humans; Male; Mercaptopurine; Methotrexate; Middle Aged; Neoplasm Metastasis; Teratoma; Testicular Neoplasms

Topics: Aminopterin; Antimetabolites; Azaserine; Child; Child, Preschool; Choriocarcinoma; Diazooxonorleucine; Female; Fluorouracil; Folic Acid Antagonists; Humans; Leukemia; Mercaptopurine; Methotrexate; Pregnancy; Pyrimethamine; Toxoplasmosis; Vitamin K; Vitamins

Topics: Antineoplastic Agents; Choriocarcinoma; Cyclophosphamide; Dactinomycin; Female; Humans; Hydatidiform Mole; Hydatidiform Mole, Invasive; Mechlorethamine; Mercaptopurine; Methotrexate; Pregnancy; Uterine Neoplasms; Vinblastine

Topics: Antisepsis; Choriocarcinoma; England; Female; Hospitals; Humans; Hydatidiform Mole; Intensive Care Units; Mercaptopurine; Methotrexate; Pregnancy; Toxicology; Trophoblastic Neoplasms; Uterine Neoplasms

Topics: Choriocarcinoma; Female; Humans; Hydatidiform Mole, Invasive; Lung Neoplasms; Mercaptopurine; Neoplasm Metastasis; Neoplasms; Pregnancy; Prognosis; Surgical Procedures, Operative; Uterine Neoplasms

Topics: Angiography; Choriocarcinoma; Chorion; Female; Humans; Hydatidiform Mole; Mercaptopurine; Methotrexate; Neoplasms; Pregnancy; Surgical Procedures, Operative; Uterine Neoplasms; Vinblastine

Topics: Air Conditioning; Antisepsis; Choriocarcinoma; Female; Hospital Design and Construction; Hospital Planning; Humans; Intensive Care Units; Mercaptopurine; Methotrexate; Neoplasms; Nursing Service, Hospital; Pregnancy

Topics: Antineoplastic Agents; Choriocarcinoma; Female; Humans; Hydatidiform Mole, Invasive; Mercaptopurine; Pregnancy; Uterine Neoplasms

Topics: Antineoplastic Agents; Brain Neoplasms; Castration; Choriocarcinoma; Female; Humans; Hydatidiform Mole, Invasive; Hysterectomy; Lung Neoplasms; Mercaptopurine; Methotrexate; Neoplasm Metastasis; Neoplasms; Pregnancy; Trophoblastic Neoplasms; Uterine Neoplasms

Topics: Choriocarcinoma; Electrocardiography; Female; Humans; Hydatidiform Mole; Lung Neoplasms; Mercaptopurine; Methotrexate; Neoplasm Metastasis; Pregnancy; Uterine Neoplasms