“…In women older than 50 years, the risk of post-evacuation GTN may be as high as 60%, regardless of presenting hCG level [39], though population based studies place this risk for older women around 30% [10]. For these women, or for those in whom reliable hCG follow up cannot be obtained, hysterectomy should be considered [39][40][41]. Although use of prophylactic chemotherapy at the time of hysterectomy for molar pregnancy has been shown to decrease the risk of developing GTN, for those that do develop GTN despite prophylactic chemotherapy, there is often a delayed diagnosis, increase drug resistance, exposure to toxicity, and worse outcome [42,43].…”