ABSTRACT
Amaç: Gestasyonel trofoblastik neoplazilerde (GTN) tedavi yöntemleri ve prognozun incelenmesi. Gereç ve Yöntemler: GTN tanısı alan 112 hastaya suction küretaj uygulandı. Küretaj materyali sitopatolojik incelemeye gönderildi. Çocuk isteği olmayan ileri yaştaki hastalara histerektomi uygulandı. Metastaz yapmamış koryokarsinomlarda veya persistan hastalığı olanlarda tek ajanlı kemoterapi, tek ajanlı kemoterapiye cevap vermeyen veya yüksek riskli hastalarda kombine kemoterapi uygulandı. Bulgular: Yetmiş bir (%63.3) hastada komplet, 15 (%13.2) hastada parsiyel, 22 (%20) hastada invaziv mol ve 4 (%3.5) hastada koryokarsinom tespit edildi. GTN insidansı %0.73, molar gebelik oranı %0.58 ve gestasyonel koryokarsinom oranı %0.02 idi. Bütün hastalara suction küretaj uygulandı. Hastaların %76.7'sinde hCG seviyeleri 6 hafta içinde normale döndü. Hastaların %20'sinde küretaj sonrası persistan hastalık gelişti. Persistans gelişen hastaların 11'ine (%50) tek ajanlı kemoterapi uygulandı. Çocuk isteği olmayan yaşı 40'ın üzerinde 9 hastaya (%40.9) histerektomi uygulandı. 2 hastaya da hem histerektomi hem kemoterapi verildi. Koryokarsinom olan bir hastaya ve tek ajanlı kemoterapiye cevap vermeyen 2 hastaya MAC protokolü uygulandı. Koryokarsinomlu 3 hastaya ve MAC protokolüne cevap vermeyen 1 hastaya EMA-CO rejimi uygulandı. Kemoterapi sonrası hormon seviyeleri ortalama 9 haftada (4-13) normale döndü. İnvaziv mol grubundaki tüm hastalar 10 haftada, koryokarsinomlu vakalar 12-13 haftada remisyona girdi. Sonuç: Gestasyonel trofoblastik neoplazilerde ideal yönetim kesin tanıya, risk kategorisinin doğru olarak belirlenmesine ve uygun tedavinin (kemoterapi veya cerrahi) verilmesine bağlıdır.

ÖZET
Objective: Aim of this study was to examine treatment strategies and prognosis of Gestational Trophoblastic Neoplasms (GTN). Material and Methods: Suction curettage was applied to 112 patients having the diagnosis of GTN and curettage material was sent for cytopathologic examination. Hysterectomy was done to older patients without child desire. Single agent chemotherapy was applied to the patients with persistant disease or nonmetastatic choriocarcinoma and combined chemotherapy in high risk patients and cases unresponsive to single agent chemotherapy. Results: Complete mole was detected in 71 (63.3%) patients, partial mole in 15 (13.2%), invasive mole 22 (20%) and choriocarcinoma in 4 (3.5%) patients. Incidence of GTN was 0.73%. Molar pregnancy rate was 0.58%. Gestational choriocarcinoma rate was found as 0.02%. Suction curettage was applied to all patients. After curretage hCG levels turned to normal in 6 weeks in 76.7% of patients. 20% of patients developed persistant disease after the evacuation of molar pregnancy. Single agent chemoteraphy was applied to 11 (50%) patients with persistence. Hysterectomy was applied to 9 (40.9%) patients over the age of 40 years without child desire. Both hysterectomy and chemotherapy were applied to 2 patients. 2 patients in invasive mole group who didn't enter remission with single agent chemoteraphy and 1 patient with choriocarcinoma were treated with MAC regimen. EMA-CO regimen was given to 3 patients with choriocarcinoma and other choriocarcinoma patient who didn't enter remission with MAC regimen. Hormon levels turned to normal in 9 weeks (4-13) after chemotherapy. All cases in invasive mole group entered remission in 10 weeks. Cases with choriocarcinoma entered remission in 12-13 weeks. Discussion: The optimal management of gestational trophoblastic neoplasms depends on prompt diagnosis, correct stratification of the risk category and appropriate treatment using various modalities such as chemotherapy and surgery.