Second Uterine Curettage and the Number of Chemotherapy Courses in Postmolar Gestational Trophoblastic Neoplasia: A Randomized Controlled Trial

Reda Hemida, Elvira L Vos, Basem El-Deek, Mohammad Arafa, Eman Toson, Curt W Burger, Helena C van Doorn

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16 Citations (Scopus)

Abstract

OBJECTIVE: To investigate the effect of second uterine curettage on the number of chemotherapy courses and relapse rate in low-risk postmolar gestational trophoblastic neoplasia.

METHODS: In a phase III trial, patients with low risk gestational trophoblastic neoplasia were randomised (1:1) to a second curettage or no curettage group before methotrexate treatment. Eligibility criteria were serum human chorionic gonadotropin (hCG) level 5,000 international units/L or less and fit for treatment with methotrexate. Exclusion criteria were previous uterine perforation and life-threatening bleeding. With a two-sided 5% significance level and a power of 99%, a sample size of 44 patients per group was necessary to detect a mean reduction in 2.3 chemotherapy courses. The primary outcome was the number of chemotherapy courses required for hCG normalization. Secondary outcomes were needed for second-line treatment, toxicity, relapse rates, and variables associated with number of chemotherapy courses.

RESULTS: From October 2011 through February 2016, 89 patients entered the study at the Mansoura Trophoblastic Clinic; in each group, 43 patients were included in the intention-to-treat analyses. Surgical complications did not occur. The mean number of chemotherapy courses required to reach hCG normalization was 4.4±2.2 SD in the control group vs 3.8±2.3 SD in the intervention group (P=.14). Groups were comparable in terms of second-line treatment needed to reach hCG normalization, and relapse within the first year. Only hCG levels related to the number of chemotherapy cycles required for hCG normalization.

CONCLUSION: Second uterine curettage did not reduce the number of chemotherapy courses required or affect relapse rate in patients with low-risk postmolar gestational trophoblastic neoplasia.

CLINICAL TRIALS REGISTRATION: Dutch Trial Registry, NTR3390.

Original languageEnglish
Pages (from-to)1024-1031
Number of pages8
JournalObstetrics and Gynecology
Volume133
Issue number5
DOIs
Publication statusPublished - May 2019

Keywords

  • Adult
  • Antimetabolites, Antineoplastic/administration & dosage
  • Combined Modality Therapy
  • Curettage
  • Female
  • Gestational Trophoblastic Disease/drug therapy
  • Humans
  • Methotrexate/administration & dosage
  • Pregnancy
  • Treatment Outcome
  • Uterine Neoplasms/drug therapy

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