Prevention of postmolar gestational trophoblastic neoplasia using prophylactic single bolus dose of actinomycin D in high-risk hydatidiform mole: A simple, effective, secure and low-cost approach without adverse effects on compliance to general follow-up or subsequent treatment

Uberti, Elza Maria Hartmann; Fajardo, Maria do Carmo; Cunha, Adriana Gerhardt Vieira da; Rosa, Marcos Wengrover; Ayub, Antonio Celso Koehler; Graudenz, Márcia da Silveira; Schmid, Helena

doi:10.1016/j.ygyno.2009.04.006

Cited by 25 publications

(23 citation statements)

References 31 publications

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“…Study III demonstrated that the risk of post-molar GTN after a CHM was 13% and after a PHM 2%. This result is comparable to results from other European studies (148,155), but is lower than in reports from the USA and South America, something which is usually attributed to different treatment indications rather than a true difference in the rate of post-molar GTN (156,157). The risk of malignant progression is significantly higher for CHM, which is reflected in the duration of the recommended hCG surveillance.…”

Section: Post-molar Gtnsupporting

confidence: 78%

Hydatidiform mole and subsequent pregnancy outcome: a population-based cohort study

Joneborg

Eloranta

Johansson

et al. 2014

American Journal of Obstetrics and Gynecology

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Section: Post-molar Gtnsupporting

confidence: 78%

Hydatidiform mole and subsequent pregnancy outcome: a population-based cohort study

Joneborg

Eloranta

Johansson

et al. 2014

American Journal of Obstetrics and Gynecology

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“…Since 1966, several studies have focused on the primary prevention of postmolar GTN and have evaluated prophylactic chemotherapy with methotrexate or actinomycin D, but their results have been controversial. 13 According to Berkowitz and Goldstein, hydatidiform mole can be divided into low and high risk for persistence based on signs and symptoms of marked trophoblastic proliferation at the time of evacuation, i.e. hCG >100 000 miu/ml, excessive uterine enlargement and theca lutein ovarian cyst >6 cm in diameter.…”

Section: Discussionmentioning

confidence: 99%

Gestational trophoblastic neoplasia after achieving a nondetectable serum human chorionic gonadotrophin level

Gueye

Kane-Gueye

Ndiaye-Gueye

et al. 2014

BJOG

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Objective To determine the risk of recurrent trophoblastic disease after normalisation of human chorionic gonadotrophin (hCG) levels in women with hydatidiform mole.Design A retrospective review of data from a national gestational trophoblastic disease centre.Setting The Trophoblastic Disease Unit, Dakar, Senegal.Sample Women with pregnancies affected by hydatidiform mole registered between 2006 and 2012.Methods The women were followed up in accordance with the hospital protocol 'Score de Dakar'. For women who progressed to gestational trophoblastic neoplasia (GTN) the time to onset of GTN, treatment and evolution were evaluated. The rate of evolution to GTN after normalisation of hCG was determined.Main outcome measures Rate of occurrence of GTN after chemotherapy for hydatidiform mole.Results Five hundred and thirty-one women were diagnosed to have molar pregnancies. According to the hospital's protocol, 107 (20.2%) of these had chemotherapy and 224 (42.2%) had prophylactic chemotherapy. Five hundred and thirteen women (96.4%; 95% confidence interval [95% CI] 95.05-98.14%) achieved remission. Eighteen women (3.4%; 95% CI 1.86-4.94%) developed GTN (11 before remission and seven after remission). Seven women out of the 18 developed GTN after hCG normalisation (1.3%). Five of these seven were diagnosed beyond the recommended period of follow up. The mean interval to diagnosis of GTN was 18.7 months. These seven women underwent combination chemotherapy: five achieved complete remission whereas two died from GTN.Conclusions Cytotoxic therapy for hydatidiform mole does not prevent GTN, it delays its diagnosis and promotes GTN after normalisation of hCG.

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“…To date, the use of chemotherapy for primary prevention of post-molar GTN remains controversial as there is conflicting data regarding efficacy (Ayhan et al 1990). Patients with high-risk hydatidiform moles, as defined in Table 9, have up to a 50% chance of developing post-molar GTN (Uberti et al 2009). It has been argued that chemotherapy administered at the time of uterine evacuation in this patient population can prevent the development of GTN; however, studies have shown that prophylactic chemotherapy is not without risk.…”

Section: Post-molar Prophylactic Chemotherapymentioning

confidence: 99%

“…Those who receive chemoprophylaxis are known to have prolonged hospital stays and chemotherapy-related toxicities and require more courses of chemotherapy to cure subsequent GTN, all of which may seem too risky for a disease with an excellent cure rate. Nevertheless, it does not affect reproductive outcomes and has also been shown to reduce psychological angst, medical visits, and operational costs associated with management of post-molar GTN/persistent GTD (Uberti et al 2009). Though the use of chemoprophylaxis is not widely accepted, most agree that its use is most appropriate for patients with high-risk moles in settings where serial beta-hCG levels cannot be followed and in those with poor compliance, such as in the adolescent population (Uberti et al 2006).…”

Section: Post-molar Prophylactic Chemotherapymentioning

confidence: 99%

Diagnosis and Management of Gestational Trophoblastic Disease

Garcia‐Sayre¹,

Castaneda²,

Roman³

et al. 2016

Handbook of Gynecology

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Gestational trophoblastic disease (GTD) refers to all tumors that arise from the maternal placenta. Gestational trophoblastic neoplasm (GTN) is a subset of GTD and refers to choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. Persistent GTD may develop after treatment of a molar pregnancy and is also referred to as GTN. The treatment of GTN is stratified based on whether the patient is low risk or high risk as determined by the World Health Organization (WHO) score and International Federation of Gynecology and Obstetrics (FIGO) staging system. Low-risk GTN is treated with singleagent chemotherapy, whereas high-risk GTN should be treated with combination regimens. GTN that does not respond to first-line treatment is said to be resistant or refractory. Resistance to a particular chemotherapeutic regimen is evidenced by a plateau or rise in beta-hCG levels. The overall prognosis for GTN is excellent, even in the setting of refractory disease. GTN affects women of reproductive age, and comprehensive counseling must be performed prior to initiation of gonadotoxic treatment. This chapter also discusses the management of GTN with special considerations such as brain and vaginal metastasis, role of secondary curettage, and post-molar prophylactic chemotherapy.

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Prevention of postmolar gestational trophoblastic neoplasia using prophylactic single bolus dose of actinomycin D in high-risk hydatidiform mole: A simple, effective, secure and low-cost approach without adverse effects on compliance to general follow-up or subsequent treatment

Cited by 25 publications

References 31 publications

Hydatidiform mole and subsequent pregnancy outcome: a population-based cohort study

Hydatidiform mole and subsequent pregnancy outcome: a population-based cohort study

Gestational trophoblastic neoplasia after achieving a nondetectable serum human chorionic gonadotrophin level

Diagnosis and Management of Gestational Trophoblastic Disease

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