Pierre-Adrien Bolze1, Mélodie Mathe2, Touria Hajri3, Benoit You4, Yohann Dabi5, Anne-Marie Schott3, Sophie Patrier6, Jérôme Massardier7, François Golfier8. 1. University of Lyon 1, University Hospital Lyon Sud, Department of Gynecological Surgery and Oncology, Obstetrics, Pierre Bénite, France; French Center for Trophoblastic Diseases, University Hospital Lyon Sud, Pierre Bénite, France. 2. University of Lyon 1, University Hospital Femme Mere Enfant, Department of Obstetrics and Gynecology, Bron, France. 3. French Center for Trophoblastic Diseases, University Hospital Lyon Sud, Pierre Bénite, France; Pôle Information Médicale Evaluation Recherche, Equipe d'Accueil 4129, Hospices Civils de Lyon, France. 4. French Center for Trophoblastic Diseases, University Hospital Lyon Sud, Pierre Bénite, France; Medical Oncology, Investigational Center for Treatments in Oncology and Hematology of Lyon (CITOHL), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France. 5. Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Créteil, France; Faculté de médecine de Créteil UPEC - Paris XII, France. 6. French Center for Trophoblastic Diseases, University Hospital Lyon Sud, Pierre Bénite, France; Department of Pathology, University Hospital of Rouen, Rouen, France. 7. French Center for Trophoblastic Diseases, University Hospital Lyon Sud, Pierre Bénite, France; University of Lyon 1, University Hospital Femme Mere Enfant, Department of Obstetrics and Gynecology, Bron, France. 8. University of Lyon 1, University Hospital Lyon Sud, Department of Gynecological Surgery and Oncology, Obstetrics, Pierre Bénite, France; French Center for Trophoblastic Diseases, University Hospital Lyon Sud, Pierre Bénite, France. Electronic address: francois.golfier@chu-lyon.fr.
Abstract
BACKGROUND: Low-risk gestational trophoblastic neoplasia (GTN) patients (FIGO score ≤6) are generally treated with single agent chemotherapy (methotrexate or dactinomycin) resulting in a 5-year mortality rate of 0.3%. However, despite these encouraging survival rates, chemotherapy is associated with significant adverse events in most patients. Although it is generally accepted that patients who no longer wish to conceive may be treated by hysterectomy for a hydatidiform mole, the evidence to support this strategy in low-risk GTN patients is lacking. OBJECTIVES: To describe the survival, efficacy, and tolerance associated with first-line hysterectomy in low-risk non-metastatic GTN patients. STUDY DESIGN: Seventy-four of 1072 low-risk GTN patients treated in the French Center underwent first-line hysterectomy. Patients data with successful first-line hysterectomy were retrospectively compared to those requiring further salvage chemotherapy. RESULTS: First-line hysterectomy was followed by hCG normalization in 61 patients (82.4%, 95% confidence interval [CI] 71.8-90.3) without any further salvage chemotherapy, whereas 13 patients required salvage chemotherapy. After multivariate analysis, a FIGO score of 5-6 (exact OR 8.961, 95%CI 1.60-64.96), and the presence of choriocarcinoma (exact OR 14.295, 95%CI 1.78-138.13) were associated with the risk of requiring salvage chemotherapy. CONCLUSION: Hysterectomy as a first-line treatment is effective without salvage chemotherapy in 82.4% of women with low-risk non-metastatic GTN and can be presented as an alternative to single-agent chemotherapy when childbearing considerations have been fulfilled. In young patients, this therapeutic option should not be considered because single-agent chemotherapies are curative in nearly 100% of patients while maintaining fertility.
BACKGROUND: Low-risk gestational trophoblastic neoplasia (GTN) patients (FIGO score ≤6) are generally treated with single agent chemotherapy (methotrexate or dactinomycin) resulting in a 5-year mortality rate of 0.3%. However, despite these encouraging survival rates, chemotherapy is associated with significant adverse events in most patients. Although it is generally accepted that patients who no longer wish to conceive may be treated by hysterectomy for a hydatidiform mole, the evidence to support this strategy in low-risk GTN patients is lacking. OBJECTIVES: To describe the survival, efficacy, and tolerance associated with first-line hysterectomy in low-risk non-metastatic GTN patients. STUDY DESIGN: Seventy-four of 1072 low-risk GTN patients treated in the French Center underwent first-line hysterectomy. Patients data with successful first-line hysterectomy were retrospectively compared to those requiring further salvage chemotherapy. RESULTS: First-line hysterectomy was followed by hCG normalization in 61 patients (82.4%, 95% confidence interval [CI] 71.8-90.3) without any further salvage chemotherapy, whereas 13 patients required salvage chemotherapy. After multivariate analysis, a FIGO score of 5-6 (exact OR 8.961, 95%CI 1.60-64.96), and the presence of choriocarcinoma (exact OR 14.295, 95%CI 1.78-138.13) were associated with the risk of requiring salvage chemotherapy. CONCLUSION: Hysterectomy as a first-line treatment is effective without salvage chemotherapy in 82.4% of women with low-risk non-metastatic GTN and can be presented as an alternative to single-agent chemotherapy when childbearing considerations have been fulfilled. In young patients, this therapeutic option should not be considered because single-agent chemotherapies are curative in nearly 100% of patients while maintaining fertility.
Authors: Hextan Y S Ngan; Michael J Seckl; Ross S Berkowitz; Yang Xiang; François Golfier; Paradan K Sekharan; John R Lurain; Leon Massuger Journal: Int J Gynaecol Obstet Date: 2021-10 Impact factor: 4.447
Authors: C K Ramesan; Dhanya Susan Thomas; Ajit Sebastian; Vinotha Thomas; Anitha Thomas; Rachel George; Abraham Peedicayil Journal: Indian J Surg Oncol Date: 2021-04-29