A conservative approach in persistent low-level elevation of serum beta-human chorionic gonadotropin following chemotherapy for gestational trophoblastic neoplasia
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Melanie Boafo-Yirenki1, Janet Everard, John Tidy
1Sheffield Trophoblast Centre, Weston Park Hospital, Whitham Road, Sheffield, United Kingdom.
Objective:
To question whether patients with persistent low-level elevation of beta-human chorionic gonadotropin (beta-hCG) following chemotherapy for gestational trophoblastic neoplasia can be managed conservatively.
Study Design:
A retrospective study of all patients requiring chemotherapy for gestational trophoblastic neoplasia (GTN), treated in Sheffield from 1994 to 2007, evaluating those for whom a clinical decision was made to stop chemotherapy when the serum beta-hCG level remained elevated.
Results:
Of the 350 patients requiring chemotherapy, 17 had persistently elevated beta-hCG at the time chemotherapy was stopped. The range of elevation was 4-43 IU/L (mean, 7.5) and duration 3-32 weeks (mean, 10.7). In 16 patients, beta-hCG became undetectable and further treatment was not required; in only 1 patient did the level suddenly become elevated (from 12 to 77 IU/L after 3 months), requiring further and curative chemotherapy.
Conclusion:
These results suggest that a conservative but watchful approach can be taken for persistent low-level elevation (up to 40 IU/L) of serum beta-hCG following chemotherapy.
