Effectiveness and Efficiency Comparison of One-Day vs Eight-Day Methotrexate Protocols in Managing Low-Risk Gestational Trophoblastic Neoplasia

Vidiatma Agbari,1,* Yudi Mulyana Hidayat,1,* Andi Kurniadi,1,* Siti Salima,1,* Ali B Harsono,1 Dodi Suardi,1 Hariadi Yuseran,2 Desy Lisnasari3 1Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University, Dr Hasan Sadikin General Hospital Bandung, Bandung, West Java, Indonesia; 2Department of Obstetrics and Gynecology, Faculty of Medicine, Lambung Mangkurat University, Ulin Regional General Hospital, Banjarmasin, South Kalimatan, Indonesia; 3Faculty of Medicine, Jenderal Ahmad Yani University, Cimahi, West Java, Indonesia*These authors contributed equally to this workCorrespondence: Vidiatma Agbari, Email [email protected]: Gestational Trophoblastic Neoplasia (GTN) has a high incidence in Bandung, Indonesia, with a mortality rate between 31% and 51%. The most common type is low-risk GTN with various treatment protocols available. The 8-day Methotrexate (MTX) 50 mg protocol has been implemented at our center; however, due to limitation of government insurance, this study aims to compare its effectiveness against the 1-day Methotrexate (MTX) 300 mg/m² protocol.Methods: A retrospective cohort study compared two protocols for low-risk GTN treatment at Dr. Hasan Sadikin General Hospital from January 2020 to December 2023: a 1-day Methotrexate (MTX) 300 mg/m² protocol and an 8-day MTX protocol (50 mg MTX IM on days 1, 3, 5, 7 with folinic acid 15 mg orally 24 h after MTX on days 2, 4, 6, 8) and repeat every 2 weeks. Data on patient characteristics, chemotherapy response, side effects, and treatment costs were analyzed.Results: The 1-day MTX 300 mg/m² protocol achieved similar remission with fewer cycles, milder side effects, and reduced costs compared to the 8-day MTX 50 mg protocol, supporting it as an effective treatment option for low-risk GTN.Conclusion: The 1-day MTX 300 mg/m² protocol is as an effective treatment option for low-risk GTN compared to the 8-day MTX 50 mg protocol.Keywords: gestational trophoblastic neoplasia, low risk, chemotherapy, methotrexate