A Case of Refractory Gestational Trophoblastic Neoplasia requiring Hysterectomy after Methotrexate

Gestational trophoblastic neoplasia (GTN) refers to a group of malignant conditions that develop due to abnormal fertilization causing abnormal proliferation of tissue. GTN is primarily treated with surgical evacuation of the underlying proliferative tissue. Approximately half of cases of GTN arise from molar pregnancy1. GTN include invasive moles, choriocarcinomas, placentalsite trophoblastic tumors and epithelioid trophoblastic tumors. The most common risk factors associated with GTN are prior molar pregnancy, advanced maternal age (\u3e40 years of age), and Asian and Native American ancestry2-4. Following evaluation of a molar pregnancy, a post-molar GTN is diagnosed based on the International Federation of Gynecology and Obstetrics (FIGO) criteria, which includes elevated human chorionic gonadotropin (hCG) levels, hCG levels increasing \u3e10% across three values recorded over a two-week duration, weekly hCG level plateauing (remaining within +/- 10% of the previous week’s results) over a three-week period, and persistence of detectable serum hCG for more than six months after molar evacuation5. A pathologic diagnosis of prior molar pregnancy by curettage with increased hCG levels also would be acceptable for diagnosis. According to the World Health Organization scoring system of GTN, factors including age, antecedent pregnancy, interval months from index pregnancy, pretreatment HCG, largest tumor size, site and number of metastases and previous failed chemotherapy help stratify the risk of patients and determine the type of treatment (table 1)

Adjuvant vaginal cuff brachytherapy for high-risk, early stage endometrial cancer.

PURPOSE: To report outcomes following adjuvant high-dose-rate vaginal brachytherapy (VBT) with or without chemotherapy for high-intermediate risk (HIR) and high-risk, early stage endometrial cancer as defined in Gynecologic Oncology Group trial 0249. MATERIAL AND METHODS: From May 2000 to January 2014, 68 women with HIR and high-risk endometrial cancer underwent surgical staging followed by VBT. Median VBT dose was 21 Gy delivered in three fractions prescribed to 0.5 cm depth. Paclitaxel 175 mg/m(2) and carboplatin area under the curve 6 was administered every 21 days in sequence with VBT. Actuarial survival estimates were calculated using the Kaplan-Meier method. RESULTS: Patient demographics included a median age of 66 years (range: 36-91) and stages IA (49%), IB (38%), and II (13%), respectively. Thirty-one (46%) patients had HIR disease with endometrioid histology, and 33 (48%) patients had serous or clear cell histology. Thirty-seven (54%) patients received a median 3 cycles (range: 3-6) of chemotherapy in addition to VBT, and 65 patients (96%) completed all prescribed therapy. During a median follow up of 33.1 months (range: 4.0-161.7), four patients have recurred, including one vaginal recurrence. The 3-year estimates of vaginal, pelvic, and distant recurrences were 1.9%, 2.4%, and 9.1%, respectively. The 3-year rates of disease-free and overall survival were 87.7% and 93.9%, respectively. CONCLUSIONS: Early outcomes with adjuvant VBT with or without chemotherapy demonstrate high rates of vaginal and pelvic control for women with HIR disease. Early vaginal and pelvic relapses in high-risk patients suggest that pelvic external beam radiotherapy is warranted in this subgroup, but additional data from large phase III trials is warranted

Substance Use Homophily Among Geosocial Networking Application Using Gay, Bisexual, and Other Men Who Have Sex With Men

Geosocial networking applications (GSN apps) represent important virtual contexts in which gay, bisexual and other men who have sex with men (MSM) seek affiliation. These apps allow users to create and view public profiles, send photos and text messages, and connect with other users based on shared interests and geographic proximity. The present study examined substance use homophily among a sample of of 295 MSM recruited via a popular GSN app. Comparisons of social network members met via GSN app versus elsewhere and associations between both individual and network characteristics and recent binge drinking, marijuana use and illicit substance use were explored using bivariate tests of association and multivariate logistic regression analyses. High rates of recent binge drinking (59 %), marijuana use (37 %) and illicit substance use (27 %) were observed among participants. GSN app use greater than one year and showing naked chest or abs in a profile picture were positively associated with recent illicit substance use. In multivariate analyses, the strongest predictors of binge drinking (AOR = 3.81; 95 % CI = 1.86–7.80), marijuana use (AOR = 4.12; 95 % CI = 2.22–7.64) and illicit substance use (AOR = 6.45; 95 % CI = 3.26–12.79) were the presence of a social network member who also engaged in these behaviors. Social network interventions that target binge drinking, marijuana use and illicit substance use may be delivered via GSN apps to reduce the prevalence of substance use and related risks among MSM in these virtual contexts