The role of repeat uterine evacuation in the management of persistent gestational trophoblastic disease.
OBJECTIVE
To evaluate the role of second (and third) uterine evacuation in the management of persistent gestational trophoblastic disease (GTD).


METHODS
This was an observational study of all cases registered over a 10-year period at the Trophoblastic Disease Centre at Weston Park Hospital, Sheffield. Five hundred and forty-four of 4050 women registered during 1991-2000 underwent a second uterine evacuation following a presumptive diagnosis of persistent GTD. The reason for evacuation, hCG level prior to the procedure, histological appearances of evacuated products and the clinical outcome (in terms of the need for chemotherapy) were determined.


RESULTS
After a second uterine evacuation 368 patients (68%) completed the follow-up programme without further evidence of persistent disease or need for chemotherapy. If the diagnosis of persistent GTD was confirmed solely on the basis of elevated hCG levels then 171 of 282 (60%) patients did not require chemotherapy. Chemotherapy was more likely where there was histological evidence of persistent trophoblastic disease and where the urinary hCG was >1500 IU/L at the time of the repeat evacuation. Twenty-eight of 60 patients (46%) undergoing a third evacuation required chemotherapy.


CONCLUSIONS
Second uterine evacuation can be a useful therapeutic option for patients with presumed persistent trophoblastic disease not mandating immediate chemotherapy, particularly where the hCG level is <1500 IU/L. Patients with documented persistent trophoblastic disease on histological examination of the second evacuation sample are more likely to require chemotherapy. Third evacuation is not now recommended.
Pezeshki
M
M
Academic Unit of Clinical Oncology, University of Sheffield, Weston Park Hospital, Whitham Road, Sheffield S10 2SJ, UK.
Hancock
B W
BW
Silcocks
P
P
Everard
J E
JE
Coleman
J
J
Gillespie
A M
AM
Tidy
J
J
Coleman
R E
RE
D000293:Adolescent; D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D006063:Chorionic Gonadotropin / Q000378:metabolism; D003131:Combined Modality Therapy; D004107:Dilatation and Curettage; D005260:Female; D005500:Follow-Up Studies; D031901:Gestational Trophoblastic Disease / Q000188:drug therapy / Q000378:metabolism / Q000601:surgery*; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D009010:Monte Carlo Method; D010865:Pilot Projects; D012372:ROC Curve; D014594:Uterine Neoplasms / Q000188:drug therapy / Q000378:metabolism / Q000601:surgery*
D000964:Antimetabolites, Antineoplastic; D006063:Chorionic Gonadotropin; D008727:Methotrexate