title: Second Curettage for Low-Risk Nonmetastatic Gestational Trophoblastic Neoplasia.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of second uterine curettage in lieu of chemotherapy for patients with low-risk, nonmetastatic gestational trophoblastic neoplasia (GTN) and to evaluate whether response to second curettage is independent of patient age, World Health Organization (WHO) risk score, registration human chorionic gonadotropin (hCG) level, lesion size, and depth of myometrial invasion measured on ultrasound examination.
  
  
  METHODS
  This was a cooperative group multicenter prospective phase II study. Prestudy testing included quantitative hCG level, pelvic ultrasonography, and chest radiography. Patients were categorized according to WHO risk scoring criteria (low risk with a score of 0-6).
  
  
  RESULTS
  Sixty-four women with newly diagnosed low-risk, nonmetastatic GTN were enrolled. Four patients were excluded. Twenty-four patients (40%) (lower 95% confidence limit 27.6%) were cured after second curettage. An additional two patients (3%) achieved a complete response but did not complete follow-up. Overall, 26 of 60 patients were able to avoid chemotherapy. Surgical failure was observed in 34 women (59%) and was more common in women 19 years old or younger or 40 years old or older. One case of grade 1 uterine perforation was successfully managed by observation. Four grade 1 and one grade 3 uterine hemorrhages were reported. New metastatic disease (lung) was identified in one of these women after second curettage. In three patients (surgical failures), the second curettage pathology was placental site trophoblastic tumor, and it was placental nodule in one additional patient.
  
  
  CONCLUSIONS
  Second uterine curettage as initial treatment for low-risk, nonmetastatic GTN cures 40% of patients without significant morbidity.
  
  
  BACKGROUND
  ClinicalTrials.gov, https://clinicaltrials.gov/, NCT00521118.
authors: Sunnybrook Health Sciences Center, Toronto, Ontario, Canada; the NRG Oncology Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo, New York; Spectrum Health Medical Group, Grand Rapids, Michigan; the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; the University of Colorado Cancer Center, Aurora, Colorado; New Britain General Hospital, Plainville, Connecticut; Women's Cancer Center, Las Vegas, Nevada; UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California; Royal Hallamshire Hospital, Sheffield, United Kingdom; and the University of Texas Southwestern Medical Center, Dallas, Texas.
authors: Raymond J
authors: RJ
authors: Osborne
authors: Virginia L
authors: VL
authors: Filiaci
authors: Julian C
authors: JC
authors: Schink
authors: Robert S
authors: RS
authors: Mannel
authors: Kian
authors: K
authors: Behbakht
authors: James S
authors: JS
authors: Hoffman
authors: Nick M
authors: NM
authors: Spirtos
authors: John K
authors: JK
authors: Chan
authors: John A
authors: JA
authors: Tidy
authors: David S
authors: DS
authors: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D006063:Chorionic Gonadotropin / Q000032:analysis; D003475:Curettage / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011247:Pregnancy; D011379:Prognosis; D011446:Prospective Studies; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D018570:Risk Assessment; D012307:Risk Factors; D014463:Ultrasonography / Q000379:methods; D014481:United States / Q000453:epidemiology
chemical_list: D006063:Chorionic Gonadotropin