Curative effect of second curettage for treatment of gestational trophoblastic disease - Results of the Belgian registry for gestational trophoblastic disease

Abstract

We assessed the curative effect of a second curettage in patients with persistent hCG serum levels after first curettage for a gestational trophoblastic disease (GTD). Study Design: This prospective observational study used the data of the Belgian register for GTD between July 2012 and January 2017. We analysed the data of patients who underwent a second curettage. We included 313 patients in the database. Primary endpoints were need for second curettage and chemotherapy. Results: Thirty-seven patients of the study population (12 %) underwent a second curettage. 20 had persistent human chorionic gonadotropin hormone (hCG) elevation before second curettage. Of them, 9 patients (45 %) needed no further treatment afterwards. Eleven patients (55 %) needed further chemotherapy. Nine (82 %) were cured with single-agent chemotherapy and 2 patients (18 %) needed multi-agent chemotherapy. Of the 37 patients, patients with hCG levels below 5000 IU/L undergoing a second curettage were cured without chemotherapy in 65 % versus 45 % of patients with hCG level more than 5000 IU/L. Of the ten patients with a hCG level below 1000 IU/L, eight were cured without chemotherapy. Conclusions: Patients with post-mole gestational trophoblastic neoplasia can benefit from a second curettage to avoid chemotherapy, especially when the hCG level is lower than 5000 IU/L.

Second curettage versus conventional chemotherapy in avoiding unnecessary chemotherapy and reducing the number of chemotherapy courses for patients with gestational trophoblastic neoplasia: A systematic review and meta‐analysis

“…RCOG and NCCN 24,25 claimed second curettage could be considered for selected cases, such as the serum hCG level being <1500 IU/L before second removal, while ESMO and ACOG 5,26 advocated against the use of second curettage due to its low efficacy in inducing remission or influence treatment. Moreover, additional inconsistent results have been published in recent studies 27,28 . We believe, under such conditions, a systematic review and meta‐analysis should be a feasible method to solve the controversies.…”

“…Moreover, additional inconsistent results have been published in recent studies. 27,28 We believe, under such conditions, a systematic review and meta-analysis should be a feasible method to solve the controversies. To the best of our knowledge, the present study is the first meta-analysis to reveal reducing chemotherapy courses.…”

Importance of pathological review of gestational trophoblastic diseases: results of the Belgian Gestational Trophoblastic Diseases Registry

“…Cases referred to the two centers were collected between July 2012 and December 2020. The objectives of the centers were to record and review diagnoses of gestational trophoblastic diseases, but also to provide clinical advice and assistance with follow-up 18. Cases were referred on a voluntary basis, by the initial pathologist, gynecologist, or the patient.…”

Surgical Management of Gestational Trophoblastic Disease

“…More is reported on the curative and/or debulking effect of a second curettage in GTN. The curative effect in these retrospective studies varies from 9.4% in the Dutch study by van Trommel et al [4‒7, 9, 50, 51] to 83% in the small Yarandi study (12 patients included of which 83% were cured). Whereas most studies included patients with low-risk GTN or GTN without metastases [5, 7, 51], other retrospective studies included patients with an hCG detectable 4–6 weeks after evacuation [4] or a not further defined serum hCG plateau or rise [6].…”

“…Other indications for second curettage that have been described are residual molar tissue, persistent hCG elevation, or persistent vaginal bleeding [4,5,9]. In the multicenter prospective study by Osborne et al [10] including low-risk patients with non-metastasized disease, a curative effect was found in 40% of patients.…”