Gestational trophoblastic neoplasia and evidence-based medicine.
OBJECTIVE
To determine whether protocols for the management of gestational trophoblastic neoplasia conform to the principles of evidence-based medicine.


METHODS
Protocols for the management of low- and high-risk gestational trophoblastic neoplasia were examined to determine to what extent they conformed to the principles of evidence-based medicine.


RESULTS
Nearly all current chemotherapy regimens for gestational trophoblastic neoplasia are based on the experience of management of various risk groups, variously defined. Some prospective, randomized studies were flawed by faulty selection criteria. Local population variations may influence the results of management.


CONCLUSIONS
The management of trophoblastic neoplasia is based on physician experience. Nearly all prospective, randomized studies have been flawed. There is a need for carefully planned prospective studies with stringent inclusion criteria to determine the most effective and cost-effective and least toxic therapy, particularly for low-risk neoplasia.
Kohorn
Ernest I
EI
Department Gynecology and Obstetrics, Yale University School of Medicine, New Haven, Connecticut, USA. ernest.kohorn@yale.edu
D000970:Antineoplastic Agents / Q000627:therapeutic use; D002985:Clinical Protocols / Q000592:standards*; D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D019983:Guideline Adherence; D006176:Gynecology / Q000191:economics / Q000592:standards*; D006801:Humans; D007258:Informed Consent; D008495:Medical Oncology / Q000191:economics / Q000592:standards*; D009774:Obstetrics / Q000191:economics / Q000592:standards*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D011379:Prognosis; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic / Q000592:standards; D012107:Research Design / Q000592:standards; D012307:Risk Factors; D015983:Selection Bias; D016896:Treatment Outcome
D000970:Antineoplastic Agents