Feasibility of central co-ordinated EMA/CO for gestational trophoblastic disease in the Netherlands.
OBJECTIVE
In the Netherlands, high risk gestational trophoblastic disease (GTD) patients are treated in different referral hospitals with a national working party on trophoblastic tumours having a co-ordinating function. Our purpose was to evaluate whether this policy is a satisfactory alternative to complete centralisation.


METHODS
A retrospective study of all etoposide, methotrexate, actomycin D, cyclophosphamide and vincristine (EMA/CO)-treated women in the Netherlands between 1986 and 1997. Data regarding risk factors, treatment results and toxicity were collected.


METHODS
Ten hospitals; 2 general, 6 academical and 2 oncology centres.


METHODS
Fifty EMA/CO-treated women registered by the central registration unit of the Dutch Working Party on Trophoblastic Disease.


METHODS
Patients files and quarterly reports of the Dutch Working Party.


METHODS
Cure rate and consistency of treatment in different hospitals.


RESULTS
EMA/CO treatment was administered in 10 different hospitals. All patients were discussed during the meetings of the Dutch Working Party and overall, 86% of patients were cured. Consistency in treatment was good.


CONCLUSIONS
Cure rates were comparable with results of single institution series. We conclude that treatment of high risk GTD patients in different referral hospitals with concentration of expertise in a working party is a good alternative to centralisation of treatment in GTD specialised hospitals.
van der Houwen
Clasien
C
Department of Obstetrics and Gynaecology, De Tjongerschans Hospital, Heerenveen, The Netherlands.
Rietbroek
Ron C
RC
Lok
Christianne A R
CA
Ten Kate-Booij
Marianne J
MJ
Lammes
Frits B
FB
Ansink
Anca C
AC
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage; D003609:Dactinomycin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014328:Trophoblastic Neoplasms / Q000188:drug therapy*; D014594:Uterine Neoplasms / Q000188:drug therapy*; D014750:Vincristine / Q000008:administration & dosage
D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D008727:Methotrexate