Form March1984 through June 1994. thirty-five patients with stage III GTT at low risk were involve in this study. Patients were randomly subdivided into two groups according to the first line chemotherapy regimen. Twenty-two patients had
Methotrexate(MTX) with folinic and(FA). Thirteen patients were treated with EMA (VP-16 MTX, and Actinomycin-D) regimen. Whenver the patients had normal hCG value for 3 consecutive weeks, we considered it as remission. If the patients show plateau
for
more than 2 consecutive weeks or elevation of hCG and if there is new evidence of metastasis, we used second line chemotherapy.
In the MTX group, 12 patients(54.5%) showed MTX-resistance and required second line chemotherapy. In contrast, of those 13 patients initially treated with EMA, no one showed chemoresistant disease. In the sensitive cases of MTX group, complete
remission
(CR) was achieved by 4.3 courses of chemotherapy(range, 3-6). In the EMA group, 3.9 courses(range, 3-6) were required for CR. The mean interval between the initiation of chemotherapy and induction of CR was significantly reduced in the EMA group
than
sensitive cases of MTX group(7.6 vs 11.1 weeks). The costs of therapy to induce CR in two groups were compared. The overall cost of EMA group was less expensive than that of MTX groups. In both treatment groups, there was no significant
difference
with
toxicity of drugs. According to the results of this study, we expected that EMA regimen seems tobe more effective than MTX with FA in the management of stage III GTT patients at low risk. EMA regimen also seems to prevent the development of
chemoresistant cases.
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