Methotrexate Courses for Postmolar GTN Unchanged After Re-Cutterage
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Uterine re-curettage does not affect the rounds of chemotherapy undergone by patients with postmolar gestational trophoblastic neoplasia (GTN), according to an oral presentation at the 2018 Society of Gynecologic Oncology Annual Meeting on Women's Cancer in New Orleancs.1
For this study, researchers randomly assigned patients with postmolar GTN and serum B-hCG (<5,000 IU/L) to undergo re-curettage or not; all patients received methotrexate (MTX) therapy. Patients assigned to re-curettage underwent the procedure prior to initiating MTX. All patients were stratified according to serum B-hCG levels and bleeding status.
Forty-three patients were assigned to each treatment arm. The groups had comparable baseline characteristics, such as age, parity, hCG levels, vaginal bleeding, WHO score, and body mass index.
Patients who underwent re-curettage did not experience complications, and the number of chemotherapy courses required for hCG normalization was 4.2 in the control arm vs 3.9 in the re-curettage arm.
Second-line therapy was required in 5 and 4 patients in the control arm and re-curettage arm, respectively, to reach hCG normalization.
After the initial year of follow-up, 2 patients in the standard arm and 1 patient in the re-curettage arm had relapsed.
Re-curettage has, according to the authors, no impact on the number of MTX courses required for these patients. They said that “only hCG level relates to the number of courses. This conclusion remains robust in uni- and multivariate regression analyses.”
Editor's Note: The spelling of curettage was corrected after this article was originally published.
Hemida R, el Deek B, Arafa M, et al. The impact of uterine re-curettage on the number of chemotherapy courses in treatment of post molar gestational trophoblastic neoplasia: a randomized controlled study. Oral presentation at: 2018 Society of Gynecologic Oncology Annual Meeting on Women's Cancer; March 24-27, 2018; New Orleans, LA.