April 4th, 2020

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Clinical Response to a Second Uterine Curettage in Patients with Low-risk Gestational Trophoblastic Disease: A Pilot Study
Authors:  Fariba Yarandi, M.D., Farzaneh Jafari, M.D., Hadi Shojaei, M.D., and Narges Izadi-Mood, M.D.
  OBJECTIVE: To determine the curative effect of a repeat uterine evacuation in patients with low-risk gestational trophoblastic neoplasia.

STUDY DESIGN: Patients with low-risk gestational trophoblastic neoplasia (GTN) (N=12), diagnosed according to the International Federation of Gynecology and Obstetrics 2002 guidelines, were enrolled in a prospective cohort study. Primary outcomes were need for chemotherapy after second uterine evacuation and number of chemotherapy courses needed to achieve complete remission.

RESULTS: Ten patients (83%) did not require chemotherapy and were cured by a second curettage. Two patients failed to respond to the second curettage and received single-agent chemotherapy with actinomycin-D (1.25 mg/m2 biweekly, slow intravenous administration). Both patients responded to chemotherapy as second-line therapy. A 100% remission rate was achieved, with no recurrence at the 1-year follow-up. One patient (8%) had a uterine perforation.

CONCLUSION: Second curettage has a favorable response rate. It seems reasonable to perform a second curettage in patients with low-risk GTN in settings where serum b-hCG assay follow-up is highly reliable and available. However, its potential complications and inconvenience must be discussed critically with each patient.
Keywords:  actinomycin-D, chemotherapy, choriocarcinoma, curettage, dactinomycin, epithelioid trophoblastic tumor, gestational trophoblastic disease, gestational trophoblastic neoplasia, human chorionic gonadotropin, hydatidiform mole, placental site trophoblastic tumor, second curettage, suction curettage, uterine curettage
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