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Clinical response to a second uterine curettage in patients with low-risk gestational trophoblastic disease: a pilot
Fariba Yarandi1, Farzaneh Jafari, Hadi Shojaei
1Department of Obstetrics and Gynecology, Women's Hospital, Tehran University of Medical Sciences, Iran.
Objective:
To determine the curative effect of a repeat uterine evacuation in patients with low-risk gestational trophoblastic neoplasia.
Study Design:
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.
Results:
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.
Conclusion:
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.
