title: The added value of hysterectomy in the management of gestational trophoblastic neoplasia.
abstract: Despite the undoubted effectiveness of chemotherapeutic treatment in gestational trophoblastic neoplasia (GTN), problems related to toxicity of chemotherapy and chemo-resistant disease have led to reconsideration of the use of hysterectomy. Aim of the present study was to evaluate indications for and outcome of hysterectomy in patients with GTN in a nation-wide cohort.
  
  
  
  Between 1977 and 2012, we identified all patients diagnosed with GTN and treated with hysterectomy from the Dutch national databases. Demographics, clinical characteristics and follow-up were recorded retrospectively.
  
  
  
  One hundred and nine patients (16.5% of all registered patients with GTN) underwent hysterectomy as part of their management for GTN. The majority of patients was classified as low-risk disease (74.3%), post-molar GTN (73.5%) and disease confined to the uterus (65.1%). After hysterectomy, complete remission was achieved in 66.2% of patients with localized disease and in 15.8% of patients with metastatic disease. For patients with localized disease, treated with primary hysterectomy, treatment duration was significantly shorter (mean 3.2weeks and 8.0weeks respectively, p=0.01) with lower number of administered chemotherapy cycles (mean 1.5 and 5.8 respectively, p<0.01) than patients in a matched control group.
  
  
  
  In selected cases, a hysterectomy may be an effective means to either reduce or eliminate tumor bulk. Primary hysterectomy should mainly be considered in older patients with localized disease and no desire to preserve fertility, whereas patients with chemotherapy-resistant disease may benefit from additional hysterectomy, especially when disease is localized. For patients with widespread metastatic disease, the benefit of hysterectomy lies in the removal of chemotherapy-resistant tumor bulk with subsequent effect on survival.
authors.affiliation: Department of Obstetrics and Gynecology, Radboud University Medical Centre, Nijmegen, The Netherlands. Electronic address: yalck.eysbouts@radboudumc.nl.
authors.forename: Y K
authors.initials: YK
authors.lastname: Eysbouts
authors.affiliation: Department of Obstetrics and Gynecology, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: L F A G
authors.initials: LFAG
authors.lastname: Massuger
authors.affiliation: Department for Health Evidence, Section Biostatistics, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: IntHout
authors.affiliation: Department of Gynecologic Oncology, Antoni van Leeuwenhoek - The Netherlands Cancer Institute Amsterdam, The Netherlands.
authors.forename: C A R
authors.initials: CAR
authors.lastname: Lok
authors.affiliation: Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: F C G J
authors.initials: FCGJ
authors.lastname: Sweep
authors.affiliation: Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: P B
authors.initials: PB
authors.lastname: Ottevanger
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D006063:Chorionic Gonadotropin / Q000097:blood; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D003609:Dactinomycin / Q000008:administration & dosage; D019008:Drug Resistance, Neoplasm; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000097:blood / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D007044:Hysterectomy; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D006063:Chorionic Gonadotropin; D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D008727:Methotrexate
keywords: Gestational trophoblastic disease; Gestational trophoblastic neoplasia; Hysterectomy; Surgery