Top

Published in:

Open Access 01-12-2021 | Gestational Trophoblastic Disease | Original Article

Does hysteroscopy in women with persistent gestational trophoblastic disease reduce the need for chemotherapy? A prospective, single-arm, clinical trial pilot study

Authors: Fatemeh Davari Tanha, Saghar Samimi Sede, Fariba Yarandi, Elham Shirali, Maliheh Fakehi, Zeinab Shaker, Mahsa Ghajarzadeh, Marjan Ghaemi

Published in: Gynecological Surgery | Issue 1/2021

Abstract

Background

This study aimed to describe the efficacy of hysteroscopy in the management of women with the persistent gestational trophoblastic disease (PGTD)/GTN to reduce the need for chemotherapy.

Materials and methods

This prospective, single-arm, clinical trial study was recruited in an educational referral hospital between September 2018 and September 2019. Totally, 30 participants with a history of hydatidiform mole that was managed by uterine evacuation and developed low risk persistent gestational trophoblastic disease were recruited. Hysteroscopy was performed for removal of persisted trophoblastic tissue. Serum beta-hCG titer was measured before and 7 days after the procedure.

Results

The mean ± SD age of the participants was 31.4 ± 4.6 years. There was a significant difference (p = 0.06) between that mean ± SD of beta-hCG titer before (8168.4 ± 1758) and after (2648.8 ± 5888) hysteroscopy. Only two (6.6%) cases underwent chemotherapy due to no drop in the beta-hCG titer.

Conclusion

Hysteroscopy may play a significant role in the management of GTN, although it requires validation in larger prospective randomized studies and longer follow-up.

Rein DT, Schmidt T, Hess AP, Volkmer A, Schondorf T, Breidenbach M (2011) Hysteroscopic management of residual trophoblastic tissue is superior to ultrasound-guided curettage. J Minim Invasive Gynecol 18(6):774–778CrossRef

Candelier JJ (2016) The hydatidiform mole. Cell Adhes Migr 10(1-2):226–235CrossRef

Candelier JJ (2015) Complete hydatidiform mole. Med Sci 31(10):861–868

Vassilakos P, Riotton G, Kajii T (1977) Hydatidiform mole: two entities. A morphologic and cytogenetic study with some clinical consideration. Am J Obstet Gynecol 127(2):167–170CrossRef

Altieri A, Franceschi S, Ferlay J, Smith J, La Vecchia C (2003) Epidemiology and aetiology of gestational trophoblastic diseases. Lancet Oncol 4(11):670–678CrossRef

Lurain JR (2010) Gestational trophoblastic disease I: epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease, and management of hydatidiform mole. Am J Obstet Gynecol 203(6):531–539CrossRef

Sand PK, Lurain JR, Brewer JI (1984) Repeat gestational trophoblastic disease. Obstet Gynecol 63(2):140–144PubMed

Akinlaja O, McKendrick R, Mashak Z, Nokkaew M (2016) Incidental finding of persistent hydatidiform mole in an adolescent on Depo-Provera. Case Rep Obstet Gynecol 2016:6075049PubMedPubMedCentral

Sasaki S (2003) Clinical presentation and management of molar pregnancy. Best Pract Res Clin Obstet Gynaecol 17(6):885–892CrossRef

10.

Padron L, Rezende Filho J, Amim Junior J, Sun SY, Charry RC, Maesta I et al (2018) Manual compared with electric vacuum aspiration for treatment of molar pregnancy. Obstet Gynecol 131(4):652–659CrossRef

11.

Wolfberg AJ, Berkowitz RS, Goldstein DP, Feltmate C, Lieberman E (2005) Postevacuation hCG levels and risk of gestational trophoblastic neoplasia in women with complete molar pregnancy. Obstet Gynecol 106(3):548–552CrossRef

12.

Lima LLA, Padron L, Camara R, Sun SY, Rezende JF, Braga A (2017) The role of surgery in the management of women with gestational trophoblastic disease. Rev Col Bras Cir 44(1):94–101CrossRef

13.

Kohorn EI (2001) The new FIGO 2000 staging and risk factor scoring system for gestational trophoblastic disease: description and critical assessment. Int J Gynecol Cancer 11(1):73–77CrossRef

14.

Kohorn EI (2002) Negotiating a staging and risk factor scoring system for gestational trophoblastic neoplasia. A progress report. J Reprod Med 47(6):445–450PubMed

15.

Ngan HY, Bender H, Benedet JL, Jones H, Montruccoli GC, Pecorelli S et al (2003) Gestational trophoblastic neoplasia, FIGO 2000 staging and classification. Int J Gynaecol Obstet 83(Suppl 1):175–177CrossRef

16.

Thomson AJA, Jason AB, Deans R, Kingston A, Vancaillie TGB (2009) The management of intrauterine synechiae. Curr Opin Obstet Gynecol 21(4):335–341CrossRef

17.

Faivre E, Deffieux X, Mrazguia C et al (2009) Hysteroscopic management of residual trophoblastic tissue and reproductive outcome: a pilot stu. J Minim Invasive Gynecol 16(4):487–490CrossRef

18.

Yarandi F, Jafari F, Shojaei H, Izadi-Mood N (2014) Clinical response to a second uterine curettage in patientswith low-risk gestational trophoblastic disease: a pilot study. J Reprod Med 59(11-12):566–570PubMed

19.

Osborne RJFV, Schink JC et al (2016) Second Curettage for Low-Risk Nonmetastatic Gestational Trophoblastic Neoplasia. Obstet Gynecol 128(3):535–542CrossRef

20.

Pezeshki MHB, Silcocks P, Everard JE, Coleman J, Gillespie AM, Tidy J, Coleman RE (2004) The role of repeat uterine evacuation in the management of persistent gestational trophoblastic disease. Gynecol Oncol 95(3):423–429CrossRef

Title: Does hysteroscopy in women with persistent gestational trophoblastic disease reduce the need for chemotherapy? A prospective, single-arm, clinical trial pilot study
Authors: Fatemeh Davari Tanha
Saghar Samimi Sede
Fariba Yarandi
Elham Shirali
Maliheh Fakehi
Zeinab Shaker
Mahsa Ghajarzadeh
Marjan Ghaemi
Publication date: 01-12-2021
Publisher: Springer Berlin Heidelberg
Keywords: Gestational Trophoblastic Disease
Hysteroscopy
Cytostatic Therapy
Published in: Gynecological Surgery / Issue 1/2021
Print ISSN: 1613-2076
Electronic ISSN: 1613-2084
DOI: https://doi.org/10.1186/s10397-021-01094-7

At a glance: The STEP trials

Springer Medicine

Does hysteroscopy in women with persistent gestational trophoblastic disease reduce the need for chemotherapy? A prospective, single-arm, clinical trial pilot study

Abstract

Background

Materials and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2021

Effects of delayed suprapubic port removal on post-laparoscopic shoulder pain: a randomized controlled trial

Defining the limits of caesarean scar niche repair: new anatomical landmarks

Emergency peripartum hysterectomy in a tertiary teaching hospital in Northern Jordan: a 15-year review

Indocyanine green fluorescence imaging, sentinel lymph node mapping in patients with vulvar cancer: peritumoral injection dosage and waiting times in our experience

Dissection of the uterine wall in a scarred uterus: a case report

A novel approach to minimally invasive hysterectomy without the use of a uterine manipulator: Kamran’s TLH