title: Clinical response to a second uterine curettage in patients with low-risk gestational trophoblastic disease: a pilot study.
abstract: OBJECTIVE
  To determine the curative effect of a repeat uterine evacuation in patients with low-risk gestational trophoblastic neoplasia.
  
  
  METHODS
  Patients with low-risk gestational trophoblastic neoplasia (GTN)(N=12), diagnosed according to the International Federation of Gynecology and Obstetrics 2002 guidelines, were enrolled in a prospective cohort study. Primary outcomes were need for chemotherapy after second uterine evacuation and number of chemotherapy courses needed to achieve complete remission.
  
  
  RESULTS
  Ten patients (83%) did not require chemotherapy and were cured bya second curettage. Two patients failed to respond to the second curettage and received single-agent chemotherapy with actinomycin-D (1.25 mg/m2 biweekly, slow intravenous administration). Both patients responded to chemotherapy as second-line therapy. A 100% remission rate was achieved, with no recurrence at the 1-year follow-up. One patient (8%) had a uterine perforation.
  
  
  CONCLUSIONS
  Second curettage has a favorable response rate. It seems reasonable to perform a second curettage in patients with low-risk GTN in settings where serum beta-hCG assay follow-up is highly reliable and available. However, its potential complications and inconvenience must be discussed critically with each patient.
authors.affiliation: Department of Obstetrics and Gynecology,  Women's Hospital, Tehran University of Medical Sciences, Iran.
authors.forename: Fariba
authors.initials: F
authors.lastname: Yarandi
authors.forename: Farzaneh
authors.initials: F
authors.lastname: Jafari
authors.forename: Hadi
authors.initials: H
authors.lastname: Shojaei
authors.forename: Narges
authors.initials: N
authors.lastname: Izadi-Mood
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004107:Dilatation and Curettage / Q000379:methods*; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000601:surgery*; D006801:Humans; D010865:Pilot Projects; D011247:Pregnancy; D012086:Reoperation; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000601:surgery*; D014599:Uterus / Q000601:surgery*