Clinical response to a second uterine curettage in patients with low-risk gestational trophoblastic disease: a pilot study
Yarandi, F.; Jafari, F.; Shojaei, H.; Izadi-Mood, N.
Journal of Reproductive Medicine 59(11-12): 566-570
2014
ISSN/ISBN: 0024-7758 PMID: 25552129 Document Number: 673732
To determine the curative effect of a repeat uterine evacuation in patients with low-risk gestational trophoblastic neoplasia. Patients with low-risk gestational trophoblastic neoplasia (GTN)(N=12), diagnosed according to the International Federation of Gynecology and Obstetrics 2002 guidelines, were enrolled in a prospective cohort study. Primary outcomes were need for chemotherapy after second uterine evacuation and number of chemotherapy courses needed to achieve complete remission. Ten patients (83%) did not require chemotherapy and were cured bya second curettage. Two patients failed to respond to the second curettage and received single-agent chemotherapy with actinomycin-D (1.25 mg/m2 biweekly, slow intravenous administration). Both patients responded to chemotherapy as second-line therapy. A 100% remission rate was achieved, with no recurrence at the 1-year follow-up. One patient (8%) had a uterine perforation. Second curettage has a favorable response rate. It seems reasonable to perform a second curettage in patients with low-risk GTN in settings where serum beta-hCG assay follow-up is highly reliable and available. However, its potential complications and inconvenience must be discussed critically with each patient.