Adjuvant hysterectomy in low-risk gestational trophoblastic disease.
OBJECTIVE
To evaluate the efficacy of adjuvant hysterectomy with chemotherapy for women with low-risk gestational trophoblastic disease.


METHODS
One hundred fifteen consecutive Japanese women (16-52 years old) with low-risk gestational trophoblastic disease (46 with metastatic disease and 69 without) were treated initially with single-agent chemotherapy (etoposide in 85, methotrexate in 27, and actinomycin D in three) with or without adjuvant hysterectomy, and 97 patients (84.3%) achieved primary remission with those treatments. Eight women (9.4%) treated with etoposide required other regimens because of drug resistance or toxicities. The total dose of etoposide given to achieve primary remission was analyzed in 77 women who received etoposide alone or with adjuvant hysterectomy.


RESULTS
In 34 women with metastatic disease, the mean (+/- standard deviation [SD]) total dose of etoposide was not significantly different with and without adjuvant hysterectomy (2857 +/- 842 mg versus 2815 +/- 815 mg; P =.957; Mann-Whitney U test). However, in 43 women without metastases, the total dose of etoposide was significantly less in those who had adjuvant hysterectomies than in those who did not (1750 +/- 635 mg versus 2545 +/- 938 mg; P <.05; Mann-Whitney U test).


CONCLUSIONS
Adjuvant hysterectomy decreased the total dose of etoposide given to achieve primary remission in women with nonmetastatic, low-risk gestational trophoblastic disease. If the lesions of gestational trophoblastic disease are confined to the uterus and the woman has no desire to preserve fertility, she should be informed of adjuvant hysterectomy as a treatment option.
Department of Obstetrics and Gynecology, Chiba University School of Medicine, Chiba, Japan.
K
K
Suzuka
H
H
Matsui
Y
Y
Iitsuka
K
K
Yamazawa
K
K
Seki
S
S
Sekiya
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D003609:Dactinomycin / Q000627:therapeutic use; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011247:Pregnancy; D016896:Treatment Outcome; D014328:Trophoblastic Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000601:surgery*
D000970:Antineoplastic Agents; D003609:Dactinomycin; D005047:Etoposide; D008727:Methotrexate