title: The curative effect of a second curettage in persistent trophoblastic disease: a retrospective cohort survey.
abstract: OBJECTIVE
  To assess the curative effect of a second curettage in patients with low-risk Persistent Trophoblastic Disease (PTD) after molar pregnancy.
  
  
  METHODS
  A retrospective cohort survey was performed on 2122 patients registered with the Dutch Central Registry for Hydatidiform Moles between 1987 and 2003. Of these, 422 patients developed PTD. For various reasons, 128 patients were excluded. The study group comprised 85 patients with, according to the Dutch guidelines, low-risk PTD who underwent a second therapeutic curettage as a part of the treatment for PTD. The control group consisted of 209 patients with low-risk PTD who did not undergo a second curettage. Patients in the study and control group were classified for high/low-risk PTD according to the internationally accepted FIGO 2000 guidelines. Primary outcome measures were the need for chemotherapy and if applicable, the number of chemotherapy courses.
  
  
  RESULTS
  After second curettage, eight out of 85 patients (9.4%) did not need additional chemotherapy which significantly differs from the 209 patients in the control group who all needed chemotherapy (P < 0.001). A debulking effect of the second curettage was observed: a median of 6 courses (interquartile range 3 courses) in the control group versus 5 courses (interquartile range 3 courses) in the study group (P = 0.036). Four out of the 85 (4.8%) patients with a second curettage had a major complication (uterine perforation or hemorrhage), which was managed conservatively.
  
  
  CONCLUSIONS
  A second curettage cured 9.4% of patients with PTD in this historical cohort and reduces the number of courses of chemotherapy. A second curettage seems to benefit only a limited number of patients with PTD. A randomized controlled prospective trial is needed to confirm this observation.
authors.affiliation: Department of Chemical Endocrinology, 530 ACE, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: Nienke E
authors.initials: NE
authors.lastname: van Trommel
authors.forename: Leon F A G
authors.initials: LF
authors.lastname: Massuger
authors.forename: René H M
authors.initials: RH
authors.lastname: Verheijen
authors.forename: Fred C G J
authors.initials: FC
authors.lastname: Sweep
authors.forename: Chris M G
authors.initials: CM
authors.lastname: Thomas
mesh_terms: D000328:Adult; D006063:Chorionic Gonadotropin / Q000097:blood; D015331:Cohort Studies; D003475:Curettage / Q000379:methods; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000097:blood / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D006801:Humans; D006828:Hydatidiform Mole / Q000097:blood / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D002955:Leucovorin / Q000008:administration & dosage; D008727:Methotrexate / Q000008:administration & dosage; D009367:Neoplasm Staging; D011247:Pregnancy; D012086:Reoperation; D012189:Retrospective Studies
chemical_list: D006063:Chorionic Gonadotropin; D002955:Leucovorin; D008727:Methotrexate