Second Curettage for Low-Risk Nonmetastatic Gestational Trophoblastic Neoplasia

Raymond J. Osborne, Virginia L. Filiaci, Julian C. Schink, Robert S. Mannel, Kian Behbakht, James S. Hoffman, Nick M. Spirtos, John K. Chan, John A. Tidy, David S. Miller

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

OBJECTIVE: To evaluate the efficacy and safety of second uterine curettage in lieu of chemotherapy for patients with low-risk, nonmetastatic gestational trophoblastic neoplasia (GTN) and to evaluate whether response to second curettage is independent of patient age, World Health Organization (WHO) risk score, registration human chorionic gonadotropin (hCG) level, lesion size, and depth of myometrial invasion measured on ultrasound examination. METHODS: This was a cooperative group multicenter prospective phase II study. Prestudy testing included quantitative hCG level, pelvic ultrasonography, and chest radiography. Patients were categorized according to WHO risk scoring criteria (low risk with a score of 0-6). RESULTS: Sixty-four women with newly diagnosed low-risk, nonmetastatic GTN were enrolled. Four patients were excluded. Twenty-four patients (40%) (lower 95% confidence limit 27.6%) were cured after second curettage. An additional two patients (3%) achieved a complete response but did not complete follow-up. Overall, 26 of 60 patients were able to avoid chemotherapy. Surgical failure was observed in 34 women (59%) and was more common in women 19 years old or younger or 40 years old or older. One case of grade 1 uterine perforation was successfully managed by observation. Four grade 1 and one grade 3 uterine hemorrhages were reported. New metastatic disease (lung) was identified in one of these women after second curettage. In three patients (surgical failures), the second curettage pathology was placental site trophoblastic tumor, and it was placental nodule in one additional patient. CONCLUSION: Second uterine curettage as initial treatment for low-risk, nonmetastatic GTN cures 40% of patients without significant morbidity. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, https://clinicaltrials.gov/, NCT00521118.

Original languageEnglish (US)
Pages (from-to)535-542
Number of pages8
JournalObstetrics and Gynecology
Volume128
Issue number3
DOIs
StatePublished - Sep 1 2016

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Gestational Trophoblastic Disease
Curettage
Chorionic Gonadotropin
Placental Site Trophoblastic Tumor
Uterine Perforation
Drug Therapy
Uterine Hemorrhage
Radiography
Lung Diseases
Ultrasonography
Thorax
Observation
Clinical Trials

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynecology

Cite this

Osborne, R. J., Filiaci, V. L., Schink, J. C., Mannel, R. S., Behbakht, K., Hoffman, J. S., ... Miller, D. S. (2016). Second Curettage for Low-Risk Nonmetastatic Gestational Trophoblastic Neoplasia. Obstetrics and Gynecology, 128(3), 535-542. https://doi.org/10.1097/AOG.0000000000001554

Second Curettage for Low-Risk Nonmetastatic Gestational Trophoblastic Neoplasia. / Osborne, Raymond J.; Filiaci, Virginia L.; Schink, Julian C.; Mannel, Robert S.; Behbakht, Kian; Hoffman, James S.; Spirtos, Nick M.; Chan, John K.; Tidy, John A.; Miller, David S.

In: Obstetrics and Gynecology, Vol. 128, No. 3, 01.09.2016, p. 535-542.

Research output: Contribution to journalArticle

Osborne, RJ, Filiaci, VL, Schink, JC, Mannel, RS, Behbakht, K, Hoffman, JS, Spirtos, NM, Chan, JK, Tidy, JA & Miller, DS 2016, 'Second Curettage for Low-Risk Nonmetastatic Gestational Trophoblastic Neoplasia', Obstetrics and Gynecology, vol. 128, no. 3, pp. 535-542. https://doi.org/10.1097/AOG.0000000000001554
Osborne RJ, Filiaci VL, Schink JC, Mannel RS, Behbakht K, Hoffman JS et al. Second Curettage for Low-Risk Nonmetastatic Gestational Trophoblastic Neoplasia. Obstetrics and Gynecology. 2016 Sep 1;128(3):535-542. https://doi.org/10.1097/AOG.0000000000001554
Osborne, Raymond J. ; Filiaci, Virginia L. ; Schink, Julian C. ; Mannel, Robert S. ; Behbakht, Kian ; Hoffman, James S. ; Spirtos, Nick M. ; Chan, John K. ; Tidy, John A. ; Miller, David S. / Second Curettage for Low-Risk Nonmetastatic Gestational Trophoblastic Neoplasia. In: Obstetrics and Gynecology. 2016 ; Vol. 128, No. 3. pp. 535-542.
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AU - Mannel, Robert S.

AU - Behbakht, Kian

AU - Hoffman, James S.

AU - Spirtos, Nick M.

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AU - Tidy, John A.

AU - Miller, David S.

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N2 - OBJECTIVE: To evaluate the efficacy and safety of second uterine curettage in lieu of chemotherapy for patients with low-risk, nonmetastatic gestational trophoblastic neoplasia (GTN) and to evaluate whether response to second curettage is independent of patient age, World Health Organization (WHO) risk score, registration human chorionic gonadotropin (hCG) level, lesion size, and depth of myometrial invasion measured on ultrasound examination. METHODS: This was a cooperative group multicenter prospective phase II study. Prestudy testing included quantitative hCG level, pelvic ultrasonography, and chest radiography. Patients were categorized according to WHO risk scoring criteria (low risk with a score of 0-6). RESULTS: Sixty-four women with newly diagnosed low-risk, nonmetastatic GTN were enrolled. Four patients were excluded. Twenty-four patients (40%) (lower 95% confidence limit 27.6%) were cured after second curettage. An additional two patients (3%) achieved a complete response but did not complete follow-up. Overall, 26 of 60 patients were able to avoid chemotherapy. Surgical failure was observed in 34 women (59%) and was more common in women 19 years old or younger or 40 years old or older. One case of grade 1 uterine perforation was successfully managed by observation. Four grade 1 and one grade 3 uterine hemorrhages were reported. New metastatic disease (lung) was identified in one of these women after second curettage. In three patients (surgical failures), the second curettage pathology was placental site trophoblastic tumor, and it was placental nodule in one additional patient. CONCLUSION: Second uterine curettage as initial treatment for low-risk, nonmetastatic GTN cures 40% of patients without significant morbidity. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, https://clinicaltrials.gov/, NCT00521118.

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