Criteria toward the definition of nonmetastatic gestational trophoblastic disease after hydatidiform mole.

The administration of chemotherapy to a patient with persistently elevated titers of hCG without metastases after hydatidiform mole implies a diagnosis of nonmetastatic gestational trophoblastic neoplasia (NMGTN). At present, a diagnosis of NMGTN following evacuation of hydatidiform mole is usually made after a plateau of three values of hCG over 2 weeks (days x, x + 7, x + 14), and patients are given chemotherapy on the basis of such a plateau. The frequency of the diagnosis of NMGTN from four United States Centers is presently 26% and this compares with a frequency of choriocarcinoma of 16% in the prechemotherapy era. Data are presented to demonstrate that a plateau of 3 or 4 weeks may be justified before a diagnosis of NMGTN is made and chemotherapy is given in patients who may be followed up closely.