Single-dose actinomycin D: Efficacy in the prophylaxis of postmolar gestational trophoblastic neoplasia in adolescents with high-risk hydatidiform mole

Uberti, Elza Maria Hartmann; Diestel, M.C.F.; Guimarães, F.E.; Nápoli, Gilberto de; Schmid, Helena

doi:10.1016/j.ygyno.2005.12.036

Cited by 16 publications

(7 citation statements)

References 26 publications

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“…Moreover, a study that reviewed the metaanalysis results in low and high-risk pregnancies showed that the prophylactic chemotherapy could lower GTN in almost two third of the patients (Wang et al, 2017). The same results were obtained from another study, which only considered patients with high-risk molar pregnancies (Uberti et al, 2006).…”

Section: Discussionsupporting

confidence: 52%

“…Results showed that prophylactic chemotherapy could lower the GTN rate, as well as treatment costs, though the usage of this drug has no significant impact on the morbidity and diseases intensity (Vargas et al, 2014). This reduction was quantified in two studies; Uberti et al showed that the use of actinomycin D prior to suction curettage reduces the GTN rate up to 46% (Uberti et al, 2006), while Cunha et al, (2009 found this reduction rate to be 76% (Uberti et al, 2009). However, this study practiced using MTX since actinomycin D was not available in the country this study performed.…”

Section: Resultsmentioning

confidence: 99%

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Prophylactic Chemotherapy with Methotrexate Leucovorin in High-Risk Hydatidiform Mole

Aminimoghaddam

Mahmoudzadeh

Mohammadi

2020

Asian Pac J Cancer Prev

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Aim: Gestational Trophoblastic Neoplasia (GTN) is used to describe a group of malignant gestational tumors originating from the placenta. The chance of having malignant GTN is high in a high-risk molar pregnancy. The main aim of this study is to investigate the effectiveness of using prophylactic chemotherapy in high-risk molar pregnancy to prevent malignant GTN. Method: In this case-control retrospective study, all patients with high-risk mole referred to Firoozgar and Akbarabadi Hospitals affiliated with Iran University of Medical Sciences (IUMS) from 2003 to 2013 were divided into two groups of recipient and non-recipient of methotrexate prophylactic chemotherapy.Demographic information including age, parity, weight, serum βHCG before and after the intervention, level of liver function tests (LFT) and GTN were analyzed. Results: There were 102 patients with a mean age of 27.13 years (SD= 0.37), and 51 patients (50 %) received prophylactic Methotrexate (MTX), and others were the non-receivers. Finally, 23 patients (22.5%) were inflicted with GTN, and 79 (77.5 %) did not. The average time of βHCG spontaneous remission between the groups were 2.5 (SD=1.33) and 3.2 (SD=1.21), for the recipient and non-recipient, respectively, which showed a significant difference (p). Conclusion: This study concludes that prophylactic chemotherapy with MTX and leucovorin may be capable of reducing GTN, which supports the prescription of MTX in high-risk mole, especially in countries with limited resources. The toxicity of methotrexate can be reduced with the addition of leucovorin.

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Section: Discussionsupporting

confidence: 52%

Section: Resultsmentioning

confidence: 99%

Prophylactic Chemotherapy with Methotrexate Leucovorin in High-Risk Hydatidiform Mole

Aminimoghaddam

Mahmoudzadeh

Mohammadi

2020

Asian Pac J Cancer Prev

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“…However, prophylactic chemotherapy exposed 80% of patients unnecessarily to toxic side effects [ 25 ] and might lead to incomplete protection against persistent tumour [ 24 ]. Previous studies [ 9 , 26 ] reported a significant reduction in the rate of GTN transformation in adolescents and adults, while the targeted group was mostly below 40 years old, whether prophylactic chemotherapy could prevent post-molar GTN in women above 40 years old is still unclear. Our study was the first of its kind to study patients who were at least 40 years old and found that prophylactic chemotherapy could not reduce the incidence of post-molar GTN.…”

Section: Discussionmentioning

confidence: 99%

“…Tow, Savage and Tsukmoto et al [ 5 – 7 ] reported that women greater than 40 years old had a probability of 23-37% of developing persistent GTN after uterine evacuation, while the likelihood in women older than 50 years old was as high as 31-56%. In comparison, relatively younger patients had a lower probability of 15-20% [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of different therapeutic strategies for complete hydatidiform mole in women at least 40 years old: a retrospective cohort study

2017

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BackgroundThere are three main therapeutic strategies, namely expectant management (dilation and curettage only), prophylactic chemotherapy and prophylactic total hysterectomy for treating older women with complete hydatidiform mole (CHM). However, the scientific community has so far, not unanimously accepted the above-mentioned methods. The objective of this study was to evaluate the effectiveness of these therapeutic strategies in preventing post-molar gestational trophoblastic neoplasia (GTN) pertaining to patients with CHM who were at least 40 years old.MethodsHundred and seventy-one patients from our hospital who had histologically been diagnosed of CHM and underwent treatment from January 2004 to December 2013 were included. All patients were followed continuously for a minimum of 2 years after which relevant clinical data were extracted and analysed.ResultsAll patients were divided to three groups. Group 1 consisted of 124 patients, treated by expectant management, and the incidence of post-molar GTN was 37.1%. Group 2 included 12 patients who received prophylactic chemotherapy, with an incidence of 41.7%. The remaining 35 patients, Group 3, underwent prophylactic total hysterectomy, with the lowest incidence of 11.4%. A significantly lower incidence was noted in group 3 as compared to group 1 (P = 0.004). GTN patients who received prophylactic chemotherapy required, on average, longer time to be diagnosed of GTN and had higher probability of chemotherapy resistance (P = 0.031 and P = 0.024).ConclusionsThis retrospective analysis showed that prophylactic total hysterectomy was the most effective therapeutic strategy for treating CHM in women at least 40 years old of age.Electronic supplementary materialThe online version of this article (10.1186/s12885-017-3749-8) contains supplementary material, which is available to authorized users.

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“…Nevertheless, it does not affect reproductive outcomes and has also been shown to reduce psychological angst, medical visits, and operational costs associated with management of post-molar GTN/persistent GTD (Uberti et al 2009). Though the use of chemoprophylaxis is not widely accepted, most agree that its use is most appropriate for patients with high-risk moles in settings where serial beta-hCG levels cannot be followed and in those with poor compliance, such as in the adolescent population (Uberti et al 2006). Table 9 offers a scoring system for the prediction of developing GTN in women with a molar pregnancy.…”

Section: Post-molar Prophylactic Chemotherapymentioning

confidence: 99%

Diagnosis and Management of Gestational Trophoblastic Disease

Garcia‐Sayre¹,

Castaneda²,

Roman³

et al. 2016

Handbook of Gynecology

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Gestational trophoblastic disease (GTD) refers to all tumors that arise from the maternal placenta. Gestational trophoblastic neoplasm (GTN) is a subset of GTD and refers to choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. Persistent GTD may develop after treatment of a molar pregnancy and is also referred to as GTN. The treatment of GTN is stratified based on whether the patient is low risk or high risk as determined by the World Health Organization (WHO) score and International Federation of Gynecology and Obstetrics (FIGO) staging system. Low-risk GTN is treated with singleagent chemotherapy, whereas high-risk GTN should be treated with combination regimens. GTN that does not respond to first-line treatment is said to be resistant or refractory. Resistance to a particular chemotherapeutic regimen is evidenced by a plateau or rise in beta-hCG levels. The overall prognosis for GTN is excellent, even in the setting of refractory disease. GTN affects women of reproductive age, and comprehensive counseling must be performed prior to initiation of gonadotoxic treatment. This chapter also discusses the management of GTN with special considerations such as brain and vaginal metastasis, role of secondary curettage, and post-molar prophylactic chemotherapy.

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Single-dose actinomycin D: Efficacy in the prophylaxis of postmolar gestational trophoblastic neoplasia in adolescents with high-risk hydatidiform mole

Cited by 16 publications

References 26 publications

Prophylactic Chemotherapy with Methotrexate Leucovorin in High-Risk Hydatidiform Mole

Prophylactic Chemotherapy with Methotrexate Leucovorin in High-Risk Hydatidiform Mole

Comparison of different therapeutic strategies for complete hydatidiform mole in women at least 40 years old: a retrospective cohort study

Diagnosis and Management of Gestational Trophoblastic Disease

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