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Nzayisenga I, Segal R, Pritchett N, Xu MJ, Park PH, Mpanumusingo EV, Umuhizi DG, Goldstein DP, Berkowitz RS, Hategekimana V, Muhayimana C, Rubagumya F, Fadelu T, Tapela N, Mpunga T, Ghebre RG. Gestational Trophoblastic Neoplasia Treatment at the Butaro Cancer Center of Excellence in Rwanda. J Glob Oncol 2016; 2:365-374. [PMID: 28717722 PMCID: PMC5493245 DOI: 10.1200/jgo.2015.002568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Gestational trophoblastic neoplasia (GTN) is a highly treatable disease, most often affecting young women of childbearing age. This study reviewed patients managed for GTN at the Butaro Cancer Center of Excellence (BCCOE) in Rwanda to determine initial program outcomes. PATIENTS AND METHODS A retrospective medical record review was performed for 35 patients with GTN assessed or treated between May 1, 2012, and November 30, 2014. Stage, risk score, and low or high GTN risk category were based on International Federation of Gynecology and Obstetrics staging and the WHO scoring system and determined by beta human chorionic gonadotropin level, chest x-ray, and ultrasound per protocol guidelines for resource-limited settings. Pathology reports and computed tomography scans were assessed when possible. Treatment was based on a predetermined protocol stratified by risk status. RESULTS Of the 35 patients (mean age, 32 years), 26 (74%) had high-risk and nine (26%) had low-risk disease. Nineteen patients (54%) had undergone dilation and curettage and 11 (31%) had undergone hysterectomy before evaluation at BCCOE. Pathology reports were available in 48% of the molar pregnancy surgical cases. Systemic chemotherapy was initiated in 30 of the initial 35 patients: 13 (43%) received single-agent oral methotrexate, 15 (50%) received EMACO (etoposide, methotrexate, dactinomycin, cyclophosphamide, and vincristine), and two (7%) received alternate regimens. Of the 13 patients initiating methotrexate, three had their treatment intensified to EMACO. Four patients experienced treatment delays because of medication stockouts. At a median follow-up of 7.8 months, the survival probability for low-risk patients was 1.00; for high-risk patients, it was 0.63. CONCLUSION This experience demonstrates the feasibility of GTN treatment in rural, resource-limited settings. GTN is a curable disease and can be treated following the BCCOE model of cancer care.
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Affiliation(s)
- Ignace Nzayisenga
- Ignace Nzayisenga, Natalie Pritchett, Paul H. Park, Temidayo Fadelu, and Neo Tapela, Partners In Health–Inshuti Mu Buzima; Vedaste E. Mpanumusingo, Denis G. Umuhizi, Vedaste Hategekimana, Clemence Muhayimana, Fidel Rubagumya, and Tharcisse Mpunga, Rwandan Ministry of Health; Rahel G. Ghebre, Human Resources for Health Program Rwanda, Kigali, Rwanda; Roanne Segal, Ottawa University, Ottawa, Ontario, Canada; Mary J. Xu, Paul H. Park, Donald P. Goldstein, Ross S. Berkowitz, Temidayo Fadelu, and Neo Tapela, Harvard Medical School; Paul H. Park, Donald P. Goldstein, Ross S. Berkowitz, Temidayo Fadelu, and Neo Tapela, Brigham and Women’s Hospital, Boston, MA; and Rahel G. Ghebre, University of Minnesota Medical School, Minneapolis, MN, and Yale School of Medicine, New Haven, CT
| | - Roanne Segal
- Ignace Nzayisenga, Natalie Pritchett, Paul H. Park, Temidayo Fadelu, and Neo Tapela, Partners In Health–Inshuti Mu Buzima; Vedaste E. Mpanumusingo, Denis G. Umuhizi, Vedaste Hategekimana, Clemence Muhayimana, Fidel Rubagumya, and Tharcisse Mpunga, Rwandan Ministry of Health; Rahel G. Ghebre, Human Resources for Health Program Rwanda, Kigali, Rwanda; Roanne Segal, Ottawa University, Ottawa, Ontario, Canada; Mary J. Xu, Paul H. Park, Donald P. Goldstein, Ross S. Berkowitz, Temidayo Fadelu, and Neo Tapela, Harvard Medical School; Paul H. Park, Donald P. Goldstein, Ross S. Berkowitz, Temidayo Fadelu, and Neo Tapela, Brigham and Women’s Hospital, Boston, MA; and Rahel G. Ghebre, University of Minnesota Medical School, Minneapolis, MN, and Yale School of Medicine, New Haven, CT
| | - Natalie Pritchett
- Ignace Nzayisenga, Natalie Pritchett, Paul H. Park, Temidayo Fadelu, and Neo Tapela, Partners In Health–Inshuti Mu Buzima; Vedaste E. Mpanumusingo, Denis G. Umuhizi, Vedaste Hategekimana, Clemence Muhayimana, Fidel Rubagumya, and Tharcisse Mpunga, Rwandan Ministry of Health; Rahel G. Ghebre, Human Resources for Health Program Rwanda, Kigali, Rwanda; Roanne Segal, Ottawa University, Ottawa, Ontario, Canada; Mary J. Xu, Paul H. Park, Donald P. Goldstein, Ross S. Berkowitz, Temidayo Fadelu, and Neo Tapela, Harvard Medical School; Paul H. Park, Donald P. Goldstein, Ross S. Berkowitz, Temidayo Fadelu, and Neo Tapela, Brigham and Women’s Hospital, Boston, MA; and Rahel G. Ghebre, University of Minnesota Medical School, Minneapolis, MN, and Yale School of Medicine, New Haven, CT
| | - Mary J. Xu
- Ignace Nzayisenga, Natalie Pritchett, Paul H. Park, Temidayo Fadelu, and Neo Tapela, Partners In Health–Inshuti Mu Buzima; Vedaste E. Mpanumusingo, Denis G. Umuhizi, Vedaste Hategekimana, Clemence Muhayimana, Fidel Rubagumya, and Tharcisse Mpunga, Rwandan Ministry of Health; Rahel G. Ghebre, Human Resources for Health Program Rwanda, Kigali, Rwanda; Roanne Segal, Ottawa University, Ottawa, Ontario, Canada; Mary J. Xu, Paul H. Park, Donald P. Goldstein, Ross S. Berkowitz, Temidayo Fadelu, and Neo Tapela, Harvard Medical School; Paul H. Park, Donald P. Goldstein, Ross S. Berkowitz, Temidayo Fadelu, and Neo Tapela, Brigham and Women’s Hospital, Boston, MA; and Rahel G. Ghebre, University of Minnesota Medical School, Minneapolis, MN, and Yale School of Medicine, New Haven, CT
| | - Paul H. Park
- Ignace Nzayisenga, Natalie Pritchett, Paul H. Park, Temidayo Fadelu, and Neo Tapela, Partners In Health–Inshuti Mu Buzima; Vedaste E. Mpanumusingo, Denis G. Umuhizi, Vedaste Hategekimana, Clemence Muhayimana, Fidel Rubagumya, and Tharcisse Mpunga, Rwandan Ministry of Health; Rahel G. Ghebre, Human Resources for Health Program Rwanda, Kigali, Rwanda; Roanne Segal, Ottawa University, Ottawa, Ontario, Canada; Mary J. Xu, Paul H. Park, Donald P. Goldstein, Ross S. Berkowitz, Temidayo Fadelu, and Neo Tapela, Harvard Medical School; Paul H. Park, Donald P. Goldstein, Ross S. Berkowitz, Temidayo Fadelu, and Neo Tapela, Brigham and Women’s Hospital, Boston, MA; and Rahel G. Ghebre, University of Minnesota Medical School, Minneapolis, MN, and Yale School of Medicine, New Haven, CT
| | - Edgie V. Mpanumusingo
- Ignace Nzayisenga, Natalie Pritchett, Paul H. Park, Temidayo Fadelu, and Neo Tapela, Partners In Health–Inshuti Mu Buzima; Vedaste E. Mpanumusingo, Denis G. Umuhizi, Vedaste Hategekimana, Clemence Muhayimana, Fidel Rubagumya, and Tharcisse Mpunga, Rwandan Ministry of Health; Rahel G. Ghebre, Human Resources for Health Program Rwanda, Kigali, Rwanda; Roanne Segal, Ottawa University, Ottawa, Ontario, Canada; Mary J. Xu, Paul H. Park, Donald P. Goldstein, Ross S. Berkowitz, Temidayo Fadelu, and Neo Tapela, Harvard Medical School; Paul H. Park, Donald P. Goldstein, Ross S. Berkowitz, Temidayo Fadelu, and Neo Tapela, Brigham and Women’s Hospital, Boston, MA; and Rahel G. Ghebre, University of Minnesota Medical School, Minneapolis, MN, and Yale School of Medicine, New Haven, CT
| | - Denis G. Umuhizi
- Ignace Nzayisenga, Natalie Pritchett, Paul H. Park, Temidayo Fadelu, and Neo Tapela, Partners In Health–Inshuti Mu Buzima; Vedaste E. Mpanumusingo, Denis G. Umuhizi, Vedaste Hategekimana, Clemence Muhayimana, Fidel Rubagumya, and Tharcisse Mpunga, Rwandan Ministry of Health; Rahel G. Ghebre, Human Resources for Health Program Rwanda, Kigali, Rwanda; Roanne Segal, Ottawa University, Ottawa, Ontario, Canada; Mary J. Xu, Paul H. Park, Donald P. Goldstein, Ross S. Berkowitz, Temidayo Fadelu, and Neo Tapela, Harvard Medical School; Paul H. Park, Donald P. Goldstein, Ross S. Berkowitz, Temidayo Fadelu, and Neo Tapela, Brigham and Women’s Hospital, Boston, MA; and Rahel G. Ghebre, University of Minnesota Medical School, Minneapolis, MN, and Yale School of Medicine, New Haven, CT
| | - Donald P. Goldstein
- Ignace Nzayisenga, Natalie Pritchett, Paul H. Park, Temidayo Fadelu, and Neo Tapela, Partners In Health–Inshuti Mu Buzima; Vedaste E. Mpanumusingo, Denis G. Umuhizi, Vedaste Hategekimana, Clemence Muhayimana, Fidel Rubagumya, and Tharcisse Mpunga, Rwandan Ministry of Health; Rahel G. Ghebre, Human Resources for Health Program Rwanda, Kigali, Rwanda; Roanne Segal, Ottawa University, Ottawa, Ontario, Canada; Mary J. Xu, Paul H. Park, Donald P. Goldstein, Ross S. Berkowitz, Temidayo Fadelu, and Neo Tapela, Harvard Medical School; Paul H. Park, Donald P. Goldstein, Ross S. Berkowitz, Temidayo Fadelu, and Neo Tapela, Brigham and Women’s Hospital, Boston, MA; and Rahel G. Ghebre, University of Minnesota Medical School, Minneapolis, MN, and Yale School of Medicine, New Haven, CT
| | - Ross S. Berkowitz
- Ignace Nzayisenga, Natalie Pritchett, Paul H. Park, Temidayo Fadelu, and Neo Tapela, Partners In Health–Inshuti Mu Buzima; Vedaste E. Mpanumusingo, Denis G. Umuhizi, Vedaste Hategekimana, Clemence Muhayimana, Fidel Rubagumya, and Tharcisse Mpunga, Rwandan Ministry of Health; Rahel G. Ghebre, Human Resources for Health Program Rwanda, Kigali, Rwanda; Roanne Segal, Ottawa University, Ottawa, Ontario, Canada; Mary J. Xu, Paul H. Park, Donald P. Goldstein, Ross S. Berkowitz, Temidayo Fadelu, and Neo Tapela, Harvard Medical School; Paul H. Park, Donald P. Goldstein, Ross S. Berkowitz, Temidayo Fadelu, and Neo Tapela, Brigham and Women’s Hospital, Boston, MA; and Rahel G. Ghebre, University of Minnesota Medical School, Minneapolis, MN, and Yale School of Medicine, New Haven, CT
| | - Vedaste Hategekimana
- Ignace Nzayisenga, Natalie Pritchett, Paul H. Park, Temidayo Fadelu, and Neo Tapela, Partners In Health–Inshuti Mu Buzima; Vedaste E. Mpanumusingo, Denis G. Umuhizi, Vedaste Hategekimana, Clemence Muhayimana, Fidel Rubagumya, and Tharcisse Mpunga, Rwandan Ministry of Health; Rahel G. Ghebre, Human Resources for Health Program Rwanda, Kigali, Rwanda; Roanne Segal, Ottawa University, Ottawa, Ontario, Canada; Mary J. Xu, Paul H. Park, Donald P. Goldstein, Ross S. Berkowitz, Temidayo Fadelu, and Neo Tapela, Harvard Medical School; Paul H. Park, Donald P. Goldstein, Ross S. Berkowitz, Temidayo Fadelu, and Neo Tapela, Brigham and Women’s Hospital, Boston, MA; and Rahel G. Ghebre, University of Minnesota Medical School, Minneapolis, MN, and Yale School of Medicine, New Haven, CT
| | - Clemence Muhayimana
- Ignace Nzayisenga, Natalie Pritchett, Paul H. Park, Temidayo Fadelu, and Neo Tapela, Partners In Health–Inshuti Mu Buzima; Vedaste E. Mpanumusingo, Denis G. Umuhizi, Vedaste Hategekimana, Clemence Muhayimana, Fidel Rubagumya, and Tharcisse Mpunga, Rwandan Ministry of Health; Rahel G. Ghebre, Human Resources for Health Program Rwanda, Kigali, Rwanda; Roanne Segal, Ottawa University, Ottawa, Ontario, Canada; Mary J. Xu, Paul H. Park, Donald P. Goldstein, Ross S. Berkowitz, Temidayo Fadelu, and Neo Tapela, Harvard Medical School; Paul H. Park, Donald P. Goldstein, Ross S. Berkowitz, Temidayo Fadelu, and Neo Tapela, Brigham and Women’s Hospital, Boston, MA; and Rahel G. Ghebre, University of Minnesota Medical School, Minneapolis, MN, and Yale School of Medicine, New Haven, CT
| | - Fidel Rubagumya
- Ignace Nzayisenga, Natalie Pritchett, Paul H. Park, Temidayo Fadelu, and Neo Tapela, Partners In Health–Inshuti Mu Buzima; Vedaste E. Mpanumusingo, Denis G. Umuhizi, Vedaste Hategekimana, Clemence Muhayimana, Fidel Rubagumya, and Tharcisse Mpunga, Rwandan Ministry of Health; Rahel G. Ghebre, Human Resources for Health Program Rwanda, Kigali, Rwanda; Roanne Segal, Ottawa University, Ottawa, Ontario, Canada; Mary J. Xu, Paul H. Park, Donald P. Goldstein, Ross S. Berkowitz, Temidayo Fadelu, and Neo Tapela, Harvard Medical School; Paul H. Park, Donald P. Goldstein, Ross S. Berkowitz, Temidayo Fadelu, and Neo Tapela, Brigham and Women’s Hospital, Boston, MA; and Rahel G. Ghebre, University of Minnesota Medical School, Minneapolis, MN, and Yale School of Medicine, New Haven, CT
| | - Temidayo Fadelu
- Ignace Nzayisenga, Natalie Pritchett, Paul H. Park, Temidayo Fadelu, and Neo Tapela, Partners In Health–Inshuti Mu Buzima; Vedaste E. Mpanumusingo, Denis G. Umuhizi, Vedaste Hategekimana, Clemence Muhayimana, Fidel Rubagumya, and Tharcisse Mpunga, Rwandan Ministry of Health; Rahel G. Ghebre, Human Resources for Health Program Rwanda, Kigali, Rwanda; Roanne Segal, Ottawa University, Ottawa, Ontario, Canada; Mary J. Xu, Paul H. Park, Donald P. Goldstein, Ross S. Berkowitz, Temidayo Fadelu, and Neo Tapela, Harvard Medical School; Paul H. Park, Donald P. Goldstein, Ross S. Berkowitz, Temidayo Fadelu, and Neo Tapela, Brigham and Women’s Hospital, Boston, MA; and Rahel G. Ghebre, University of Minnesota Medical School, Minneapolis, MN, and Yale School of Medicine, New Haven, CT
| | - Neo Tapela
- Ignace Nzayisenga, Natalie Pritchett, Paul H. Park, Temidayo Fadelu, and Neo Tapela, Partners In Health–Inshuti Mu Buzima; Vedaste E. Mpanumusingo, Denis G. Umuhizi, Vedaste Hategekimana, Clemence Muhayimana, Fidel Rubagumya, and Tharcisse Mpunga, Rwandan Ministry of Health; Rahel G. Ghebre, Human Resources for Health Program Rwanda, Kigali, Rwanda; Roanne Segal, Ottawa University, Ottawa, Ontario, Canada; Mary J. Xu, Paul H. Park, Donald P. Goldstein, Ross S. Berkowitz, Temidayo Fadelu, and Neo Tapela, Harvard Medical School; Paul H. Park, Donald P. Goldstein, Ross S. Berkowitz, Temidayo Fadelu, and Neo Tapela, Brigham and Women’s Hospital, Boston, MA; and Rahel G. Ghebre, University of Minnesota Medical School, Minneapolis, MN, and Yale School of Medicine, New Haven, CT
| | - Tharcisse Mpunga
- Ignace Nzayisenga, Natalie Pritchett, Paul H. Park, Temidayo Fadelu, and Neo Tapela, Partners In Health–Inshuti Mu Buzima; Vedaste E. Mpanumusingo, Denis G. Umuhizi, Vedaste Hategekimana, Clemence Muhayimana, Fidel Rubagumya, and Tharcisse Mpunga, Rwandan Ministry of Health; Rahel G. Ghebre, Human Resources for Health Program Rwanda, Kigali, Rwanda; Roanne Segal, Ottawa University, Ottawa, Ontario, Canada; Mary J. Xu, Paul H. Park, Donald P. Goldstein, Ross S. Berkowitz, Temidayo Fadelu, and Neo Tapela, Harvard Medical School; Paul H. Park, Donald P. Goldstein, Ross S. Berkowitz, Temidayo Fadelu, and Neo Tapela, Brigham and Women’s Hospital, Boston, MA; and Rahel G. Ghebre, University of Minnesota Medical School, Minneapolis, MN, and Yale School of Medicine, New Haven, CT
| | - Rahel G. Ghebre
- Ignace Nzayisenga, Natalie Pritchett, Paul H. Park, Temidayo Fadelu, and Neo Tapela, Partners In Health–Inshuti Mu Buzima; Vedaste E. Mpanumusingo, Denis G. Umuhizi, Vedaste Hategekimana, Clemence Muhayimana, Fidel Rubagumya, and Tharcisse Mpunga, Rwandan Ministry of Health; Rahel G. Ghebre, Human Resources for Health Program Rwanda, Kigali, Rwanda; Roanne Segal, Ottawa University, Ottawa, Ontario, Canada; Mary J. Xu, Paul H. Park, Donald P. Goldstein, Ross S. Berkowitz, Temidayo Fadelu, and Neo Tapela, Harvard Medical School; Paul H. Park, Donald P. Goldstein, Ross S. Berkowitz, Temidayo Fadelu, and Neo Tapela, Brigham and Women’s Hospital, Boston, MA; and Rahel G. Ghebre, University of Minnesota Medical School, Minneapolis, MN, and Yale School of Medicine, New Haven, CT
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