Practical issues in the management of low-risk gestational trophoblast tumors

Using data primarily from Charing Cross Hospital in London, we examined the organization and funding of patients' care and follow-up, the value of second evacuations, the indications for treatment escalation and the results of treating patients with persistent low levels of human chorionic gonadotropin (hCG) following a molar pregnancy. In the U.K. system the total cost per patient treated is approximately $30,000. Second evacuations appear to have only a modest chance (18%) of benefit in patients with hCG levels over 5,000 IU/L. Outcome analysis of patients with low-risk gestational trophoblastic tumor (GTT) treated with methotrexate/folinic acid indicates that hCG levels in excess of500 IU/L at 7 weeks after starting are an accurate predictor of impending methotrexate resistance. For patients with hCG values under 100 IU/L at the time of treatment, a review of the 30 most recent low-risk GTT patients demonstrates a 100% cure rate with standard treatment. Low-risk GTT following a molar pregnancy is a highly curable malignancy, and cure rates approaching 100% should be expected. National or regional organization of follow-up and treatment is simple, economic and associated with enhanced outcomes when appropriate treatment policies are followed.