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Feasibility of central co-ordinated EMA/CO for gestational trophoblastic disease in the Netherlands
Clasien van der Houwen1, Ron C Rietbroek, Christianne A R Lok
1Department of Obstetrics and Gynaecology, De Tjongerschans Hospital, Heerenveen, The Netherlands.
Objective:
In the Netherlands, high risk gestational trophoblastic disease (GTD) patients are treated in different referral hospitals with a national working party on trophoblastic tumours having a co-ordinating function. Our purpose was to evaluate whether this policy is a satisfactory alternative to complete centralisation.
Design:
A retrospective study of all etoposide, methotrexate, actomycin D, cyclophosphamide and vincristine (EMA/CO)-treated women in the Netherlands between 1986 and 1997. Data regarding risk factors, treatment results and toxicity were collected.
Setting:
Ten hospitals; 2 general, 6 academical and 2 oncology centres.
Population:
Fifty EMA/CO-treated women registered by the central registration unit of the Dutch Working Party on Trophoblastic Disease.
Methods:
Patients files and quarterly reports of the Dutch Working Party.
Main Outcome Measures:
Cure rate and consistency of treatment in different hospitals.
Results:
EMA/CO treatment was administered in 10 different hospitals. All patients were discussed during the meetings of the Dutch Working Party and overall, 86% of patients were cured. Consistency in treatment was good.
Conclusions:
Cure rates were comparable with results of single institution series. We conclude that treatment of high risk GTD patients in different referral hospitals with concentration of expertise in a working party is a good alternative to centralisation of treatment in GTD specialised hospitals.