摘要
Objective.:To evaluate the efficacy of a single prophylactic dose of actinomycin D (Act-D) in the reduction of postmolar gestational trophoblastic neoplasia (GTN) in adolescents with high-risk hydatidiform mole (Hr-HM). Methods.:In a retrospective study,60 adolescents with Hr-HM were selected from a cohort of patients with gestational trophoblastic disease (GTD)-followed at Santa Casa,Porto Alegre,Brasil. Twenty-nine received a single dose of Act-D at the time of uterine evacuation as prophylactic chemotherapy (P-chem) (study group) and 31 patients with the same risk factors did not received P-chem (control group). Patient follow-up was the same in both groups. Each group was analyzed for number of adolescents with postmolar GTN,morbidity associated with postmolar GTN,and reproductive outcomes. Results.:Postmolar GTN was diagnosed in two (6.9%) adolescents (95%CI,0.0-16.1) in the study group and in 9 (29.0%) patients (95%CI,13-45) in the control group. The reduction of postmolar GTN with a single dose of Act-D used as P-chem was 76%(relative risk = 0.24; 95%CI,0.06-0.99). Adverse effects of P-chem were minor. In the follow-up,when postmolar GTN were diagnosed,severity of disease was not increased,compliance with follow-up was not reduced,and reproductive outcomes after discharge were similar. Conclusions.:P-chem with a single dose of Act-D reduced postmolar GTN in 76%during follow-up of adolescents with Hr-HM. Since this regimen may reduce treatment costs,without affecting compliance with follow-up,it can be adopted by any Trophoblastic Disease Center.
Objective.:To evaluate the efficacy of a single prophylactic dose of actinomycin D (Act-D) in the reduction of postmolar gestational trophoblastic neoplasia (GTN) in adolescents with high-risk hydatidiform mole (Hr-HM). Methods.:In a retrospective study,60 adolescents with Hr-HM were selected from a cohort of patients with gestational trophoblastic disease (GTD)-followed at Santa Casa,Porto Alegre,Brasil. Twenty-nine received a single dose of Act-D at the time of uterine evacuation as prophylactic chemotherapy (P-chem) (study group) and 31 patients with the same risk factors did not received P-chem (control group). Patient follow-up was the same in both groups. Each group was analyzed for number of adolescents with postmolar GTN,morbidity associated with postmolar GTN,and reproductive outcomes. Results.:Postmolar GTN was diagnosed in two (6.9%) adolescents (95%CI,0.0-16.1) in the study group and in 9 (29.0%) patients (95%CI,13-45) in the control group. The reduction of postmolar GTN with a single dose of Act-D used as P-chem was 76%(relative risk = 0.24; 95%CI,0.06-0.99). Adverse effects of P-chem were minor. In the follow-up,when postmolar GTN were diagnosed,severity of disease was not increased,compliance with follow-up was not reduced,and reproductive outcomes after discharge were similar. Conclusions.:P-chem with a single dose of Act-D reduced postmolar GTN in 76%during follow-up of adolescents with Hr-HM. Since this regimen may reduce treatment costs,without affecting compliance with follow-up,it can be adopted by any Trophoblastic Disease Center.
