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Comparative Study
. 2012 Jan 14;379(9811):130-5.
doi: 10.1016/S0140-6736(11)61265-8. Epub 2011 Nov 28.

Chemotherapy and human chorionic gonadotropin concentrations 6 months after uterine evacuation of molar pregnancy: a retrospective cohort study

Roshan Agarwal  1 , Suliana Teoh, Delia Short, Richard Harvey, Philip M Savage, Michael J Seckl
Affiliations
Comparative Study

Chemotherapy and human chorionic gonadotropin concentrations 6 months after uterine evacuation of molar pregnancy: a retrospective cohort study

Roshan Agarwal et al. Lancet. .

Abstract

Background: Indications for chemotherapy in gestational trophoblastic disease include raised human chorionic gonadotropin (hCG) concentrations 6 months after uterine evacuation of hydatidiform mole, even when values are falling. We aimed to establish whether chemotherapy is always necessary in these patients.

Methods: We retrospectively identified women registered between January, 1993, and May, 2008, at Charing Cross Hospital, London, UK, who had persistently high hCG concentrations 6 months after evacuation of hydatidiform mole. Rates of hCG normalisation, relapse, and death were assessed in patients continued under surveillance and those who received chemotherapy after 6 months. We postulated that a surveillance policy would be clinically acceptable if hCG values returned to normal in 75% of patients or more.

Findings: 76 (<1%) of 13,960 patients with hydatidiform moles had persistently high hCG concentrations of more than 5 IU/L 6 months after evacuation. 66 (87%) patients continued under surveillance and hCG values spontaneously returned to normal without chemotherapy in 65 (98%) of these patients. Values in one patient did not become normal because of chronic renal failure, but she remains healthy. Ten patients received chemotherapy, and hCG concentrations returned to normal in eight (80%) of these individuals (surveillance vs chemotherapy groups p=0·044) and remained slightly high (6-11 IU/L) in two without any associated clinical problems off treatment. We noted no significant differences between individuals in the surveillance and chemotherapy groups, apart from lower median hCG concentrations 6 months after evacuation in those under surveillance than in those given chemotherapy (13 IU/L, range 5-887, vs 157 IU/L, range 6-6438; p=0·004). Overall, there were no deaths in this series.

Interpretation: A surveillance policy seems to be clinically acceptable in patients with low and declining concentrations of hCG 6 months after evacuation of hydatidiform mole.

Funding: National Commissioning Group, Imperial Experimental Cancer Medicine Centre, Imperial Biomedical Research Centre, and Cancer Research UK.

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Figures

Figure 1
Figure 1
Management and outcome of patients with high hCG concentrations 6 months after evacuation of hydatidiform mole hCG=human chorionic gonadotropin.
Figure 2
Figure 2
hCG concentrations at 6 months of patients who received chemotherapy and those continued under surveillance hCG=human chorionic gonadotropin.
See this image and copyright information in PMC

Comment in

References

    1. Kajii T, Ohama K. Androgenetic origin of hydatidiform mole. Nature. 1977;268:633–634. - PubMed
    1. Fisher RA, Newlands ES. Gestational trophoblastic disease: molecular and genetic studies. J Reprod Med. 1998;43:81–97. - PubMed
    1. Fisher RA, Lawler SD, Ormerod MG, Imrie PR, Povey S. Flow cytometry used to distinguish between complete and partial hydatidiform moles. Placenta. 1987;8:249–256. - PubMed
    1. Lage JM, Mark SD, Roberts DJ, Goldstein DP, Bernstein MR, Berkowitz RS. A flow cytometric study of 137 fresh hydropic placentas: correlation between types of hydatidiform moles and nuclear DNA ploidy. Obstet Gynecol. 1992;79:403–410. - PubMed
    1. Palmer JR. Advances in the epidemiology of gestational trophoblastic disease. J Reprod Med. 1994;39:155–162. - PubMed

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