Is chemotherapy necessary for patients with molar pregnancy and human chorionic gonadotropin serum levels raised but falling at 6 months after uterine evacuation?

Detalhes bibliográficos
Autor(a) principal: Braga, Antonio
Data de Publicação: 2016
Outros Autores: Torres, Berenice, Burla, Marcelo, Maesta, Izildinha [UNESP], Sun, Sue Yazaki, Lin, Lawrence, Madi, Jose Mauro, Uberti, Elza, Viggiano, Mauricio, Elias, Kevin M., Berkowitz, Ross S.
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da UNESP
Texto Completo: http://dx.doi.org/10.1016/j.ygyno.2016.09.012
http://hdl.handle.net/11449/162218
Resumo: Objective. To compare the outcomes of Brazilian patients with molar pregnancy who continue human chorionic gonadotropin (hCG) surveillance with those treated with chemotherapy when hCG was still positive, but falling at 6 months after uterine evacuation. Methods. Retrospective chart review of 12,526 patients with hydatidiform mole treated at one of nine Brazilian reference centers from January 1990 to May 2016. Results. At 6 months from uterine evacuation', 96 (0.8%) patients had hCG levels raised but falling. In 15/96 (15.6%) patients, chemotherapy was initiated immediately per FIGO 2000 criteria, while 81/96 (84.4%) patients were managed expectantly. Among the latter, 65/81 (80.2%) achieved spontaneous remission and 16 (19.8%) developed postmolar gestational trophoblastic neoplasia (GTN). Patients who received chemotherapy following expectant management required more time for remission (11 versus 8 months; p = 0.001), had a greater interval between uterine evacuation and initiating chemotherapy (8 versus 6 months; p < 0.001), and presented with a median WHO/FIGO risk score higher than women treated according to FIGO 2000 criteria (4 versus 2, p = 0.04), but there were no significant differences in the need for multiagent treatment regimens (1/15 versus 3/16 patients, p = 0.60). None of the women relapsed, and no deaths occurred in either group. Conclusion. In order to avoid unnecessary exposure of women to chemotherapy, we no longer follow the FIGO 2000 recommendation to treat all patients with molar pregnancy and hCG raised but falling at 6 months after evacuation. Instead, we pursue close hormonal and radiological surveillance as the best strategy for these patients. (C) 2016 Elsevier Inc. All rights reserved.
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spelling Is chemotherapy necessary for patients with molar pregnancy and human chorionic gonadotropin serum levels raised but falling at 6 months after uterine evacuation?Molar pregnancyHuman chorionic gonadotropinChemotherapyObjective. To compare the outcomes of Brazilian patients with molar pregnancy who continue human chorionic gonadotropin (hCG) surveillance with those treated with chemotherapy when hCG was still positive, but falling at 6 months after uterine evacuation. Methods. Retrospective chart review of 12,526 patients with hydatidiform mole treated at one of nine Brazilian reference centers from January 1990 to May 2016. Results. At 6 months from uterine evacuation', 96 (0.8%) patients had hCG levels raised but falling. In 15/96 (15.6%) patients, chemotherapy was initiated immediately per FIGO 2000 criteria, while 81/96 (84.4%) patients were managed expectantly. Among the latter, 65/81 (80.2%) achieved spontaneous remission and 16 (19.8%) developed postmolar gestational trophoblastic neoplasia (GTN). Patients who received chemotherapy following expectant management required more time for remission (11 versus 8 months; p = 0.001), had a greater interval between uterine evacuation and initiating chemotherapy (8 versus 6 months; p < 0.001), and presented with a median WHO/FIGO risk score higher than women treated according to FIGO 2000 criteria (4 versus 2, p = 0.04), but there were no significant differences in the need for multiagent treatment regimens (1/15 versus 3/16 patients, p = 0.60). None of the women relapsed, and no deaths occurred in either group. Conclusion. In order to avoid unnecessary exposure of women to chemotherapy, we no longer follow the FIGO 2000 recommendation to treat all patients with molar pregnancy and hCG raised but falling at 6 months after evacuation. Instead, we pursue close hormonal and radiological surveillance as the best strategy for these patients. (C) 2016 Elsevier Inc. All rights reserved.Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ)Donald P. Goldstein MD Trophoblastic Tumor Registry EndowmentDyett Family Trophoblastic Disease Research and Registry EndowmentUniv Fed Fluminense, Rio de Janeiro Trophoblast Dis Ctr, Antonio Pedro Univ Hosp, Matern Sch,Matern Ward Santa Casa Misericordia Ri, Rio De Janeiro, RJ, BrazilUniv Fed Fluminense, Postgrad Program Med Sci, Niteroi, RJ, BrazilUniv Fed Rio de Janeiro, Matern Sch, Postgrad Program Perinatal Hlth, Fac Med, Rio De Janeiro, RJ, BrazilSao Paulo State Univ, Trophoblast Dis Ctr, Clin Hosp, Botucatu Med Sch,Dept Gynecol & Obstet, Botucatu, SP, BrazilUniv Fed Sao Paulo, Paulista Sch Med, Sao Paulo Hosp, Trophoblast Dis Ctr, Sao Paulo, SP, BrazilUniv Sao Paulo, Sao Paulo Clin Hosp, Trophoblast Dis Ctr, Sao Paulo, SP, BrazilCaxias Do Sul Univ, Caxias Do Sul Trophoblast Dis Ctr, Gen Hosp Caxias Do Sul, Sch Med,Ctr Biol & Hlth Sci, Caxias Do Sul, MS USAIrmandade Santa Casa Misericordia Hosp, Porto Alegre Trophoblast Dis Ctr, Mario Totta Matern Ward, Porto Alegre, RS, BrazilGoias Fed Univ, Goias Trophoblast Dis Ctr, Clin Hosp Goias, Goiania, Go, BrazilHarvard Med Sch, Brigham & Womens Hosp, New England Trophoblast Dis Ctr, Div Gynecol Oncol,Dept Obstet & Gynecol & Reprod, Boston, MA USASao Paulo State Univ, Trophoblast Dis Ctr, Clin Hosp, Botucatu Med Sch,Dept Gynecol & Obstet, Botucatu, SP, BrazilElsevier B.V.Universidade Federal Fluminense (UFF)Universidade Federal do Rio de Janeiro (UFRJ)Universidade Estadual Paulista (Unesp)Universidade Federal de São Paulo (UNIFESP)Universidade de São Paulo (USP)Caxias Do Sul UnivIrmandade Santa Casa Misericordia HospUniversidade Federal de Goiás (UFG)Harvard Med SchBraga, AntonioTorres, BereniceBurla, MarceloMaesta, Izildinha [UNESP]Sun, Sue YazakiLin, LawrenceMadi, Jose MauroUberti, ElzaViggiano, MauricioElias, Kevin M.Berkowitz, Ross S.2018-11-26T17:12:16Z2018-11-26T17:12:16Z2016-12-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article558-564application/pdfhttp://dx.doi.org/10.1016/j.ygyno.2016.09.012Gynecologic Oncology. San Diego: Academic Press Inc Elsevier Science, v. 143, n. 3, p. 558-564, 2016.0090-8258http://hdl.handle.net/11449/16221810.1016/j.ygyno.2016.09.012WOS:000389173200019WOS000389173200019.pdfWeb of Sciencereponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengGynecologic Oncology2,339info:eu-repo/semantics/openAccess2024-08-16T14:07:32Zoai:repositorio.unesp.br:11449/162218Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462024-08-16T14:07:32Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false
dc.title.none.fl_str_mv Is chemotherapy necessary for patients with molar pregnancy and human chorionic gonadotropin serum levels raised but falling at 6 months after uterine evacuation?
title Is chemotherapy necessary for patients with molar pregnancy and human chorionic gonadotropin serum levels raised but falling at 6 months after uterine evacuation?
spellingShingle Is chemotherapy necessary for patients with molar pregnancy and human chorionic gonadotropin serum levels raised but falling at 6 months after uterine evacuation?
Braga, Antonio
Molar pregnancy
Human chorionic gonadotropin
Chemotherapy
title_short Is chemotherapy necessary for patients with molar pregnancy and human chorionic gonadotropin serum levels raised but falling at 6 months after uterine evacuation?
title_full Is chemotherapy necessary for patients with molar pregnancy and human chorionic gonadotropin serum levels raised but falling at 6 months after uterine evacuation?
title_fullStr Is chemotherapy necessary for patients with molar pregnancy and human chorionic gonadotropin serum levels raised but falling at 6 months after uterine evacuation?
title_full_unstemmed Is chemotherapy necessary for patients with molar pregnancy and human chorionic gonadotropin serum levels raised but falling at 6 months after uterine evacuation?
title_sort Is chemotherapy necessary for patients with molar pregnancy and human chorionic gonadotropin serum levels raised but falling at 6 months after uterine evacuation?
author Braga, Antonio
author_facet Braga, Antonio
Torres, Berenice
Burla, Marcelo
Maesta, Izildinha [UNESP]
Sun, Sue Yazaki
Lin, Lawrence
Madi, Jose Mauro
Uberti, Elza
Viggiano, Mauricio
Elias, Kevin M.
Berkowitz, Ross S.
author_role author
author2 Torres, Berenice
Burla, Marcelo
Maesta, Izildinha [UNESP]
Sun, Sue Yazaki
Lin, Lawrence
Madi, Jose Mauro
Uberti, Elza
Viggiano, Mauricio
Elias, Kevin M.
Berkowitz, Ross S.
author2_role author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Universidade Federal Fluminense (UFF)
Universidade Federal do Rio de Janeiro (UFRJ)
Universidade Estadual Paulista (Unesp)
Universidade Federal de São Paulo (UNIFESP)
Universidade de São Paulo (USP)
Caxias Do Sul Univ
Irmandade Santa Casa Misericordia Hosp
Universidade Federal de Goiás (UFG)
Harvard Med Sch
dc.contributor.author.fl_str_mv Braga, Antonio
Torres, Berenice
Burla, Marcelo
Maesta, Izildinha [UNESP]
Sun, Sue Yazaki
Lin, Lawrence
Madi, Jose Mauro
Uberti, Elza
Viggiano, Mauricio
Elias, Kevin M.
Berkowitz, Ross S.
dc.subject.por.fl_str_mv Molar pregnancy
Human chorionic gonadotropin
Chemotherapy
topic Molar pregnancy
Human chorionic gonadotropin
Chemotherapy
description Objective. To compare the outcomes of Brazilian patients with molar pregnancy who continue human chorionic gonadotropin (hCG) surveillance with those treated with chemotherapy when hCG was still positive, but falling at 6 months after uterine evacuation. Methods. Retrospective chart review of 12,526 patients with hydatidiform mole treated at one of nine Brazilian reference centers from January 1990 to May 2016. Results. At 6 months from uterine evacuation', 96 (0.8%) patients had hCG levels raised but falling. In 15/96 (15.6%) patients, chemotherapy was initiated immediately per FIGO 2000 criteria, while 81/96 (84.4%) patients were managed expectantly. Among the latter, 65/81 (80.2%) achieved spontaneous remission and 16 (19.8%) developed postmolar gestational trophoblastic neoplasia (GTN). Patients who received chemotherapy following expectant management required more time for remission (11 versus 8 months; p = 0.001), had a greater interval between uterine evacuation and initiating chemotherapy (8 versus 6 months; p < 0.001), and presented with a median WHO/FIGO risk score higher than women treated according to FIGO 2000 criteria (4 versus 2, p = 0.04), but there were no significant differences in the need for multiagent treatment regimens (1/15 versus 3/16 patients, p = 0.60). None of the women relapsed, and no deaths occurred in either group. Conclusion. In order to avoid unnecessary exposure of women to chemotherapy, we no longer follow the FIGO 2000 recommendation to treat all patients with molar pregnancy and hCG raised but falling at 6 months after evacuation. Instead, we pursue close hormonal and radiological surveillance as the best strategy for these patients. (C) 2016 Elsevier Inc. All rights reserved.
publishDate 2016
dc.date.none.fl_str_mv 2016-12-01
2018-11-26T17:12:16Z
2018-11-26T17:12:16Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://dx.doi.org/10.1016/j.ygyno.2016.09.012
Gynecologic Oncology. San Diego: Academic Press Inc Elsevier Science, v. 143, n. 3, p. 558-564, 2016.
0090-8258
http://hdl.handle.net/11449/162218
10.1016/j.ygyno.2016.09.012
WOS:000389173200019
WOS000389173200019.pdf
url http://dx.doi.org/10.1016/j.ygyno.2016.09.012
http://hdl.handle.net/11449/162218
identifier_str_mv Gynecologic Oncology. San Diego: Academic Press Inc Elsevier Science, v. 143, n. 3, p. 558-564, 2016.
0090-8258
10.1016/j.ygyno.2016.09.012
WOS:000389173200019
WOS000389173200019.pdf
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv Gynecologic Oncology
2,339
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 558-564
application/pdf
dc.publisher.none.fl_str_mv Elsevier B.V.
publisher.none.fl_str_mv Elsevier B.V.
dc.source.none.fl_str_mv Web of Science
reponame:Repositório Institucional da UNESP
instname:Universidade Estadual Paulista (UNESP)
instacron:UNESP
instname_str Universidade Estadual Paulista (UNESP)
instacron_str UNESP
institution UNESP
reponame_str Repositório Institucional da UNESP
collection Repositório Institucional da UNESP
repository.name.fl_str_mv Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)
repository.mail.fl_str_mv
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