The use of prophylactic chemotherapy at the time of molar evacuation to reduce the incidence of proliferative trophoblastic sequelae has been still a somewhat controversial concept. The consensus now in most treatment is not indicated when there are facilities for the sensitive assay of hCG and careful follow-up of patients. However, it has been preferred to give prophylactic chemotherapy on the basis of high incidence of the disease and high rate of patients lost in follow-up in a certain areas like Far East Asia including Korea. However, basic data or reports concerning the prophylactic chemotherapy are not available in this country.
This study was performed on 81 patients with hydatidiform mole who had been treated and completed their follow-up in Hanyang University Hospital for about 5 years from Mar. 1978 to Feb. 1983 to reevaluate the effectiveness of the prophylactic chemotherapy in our circumstances on regression patterns of 13-hCG, the incidence of persistent disease, interval until persistent disease was diagnosed, the number of courses of chemotherapy to achieve the complete remission in cases of persistent disease, and the frequencies of drug toxicities.
The results were as follows:
1) Among 81 patients with hydatidiform mole 69(85.2%) demonstrated benign regression patterns of 13-hCG and 12(14.89/o) developed persistent trophoblastic disease. There was no difference in the incidence of persistent disease between the treated(8.5%) and untreated(23.5010) groups (p>0.05). Among high risk group, however, there was an increased incidence of persistent trophoblastic disease 43.7% in treated group compared to 14.307o in the untreated (p<0.05).
2) In the patients who demonstrated benign regression patterns of 13-hCG the average duration until complete remission was 9.4 5.1 weeks. There was no difference in the duration until the complete remission between the treated (10.0 5.8 wks) and untreated (8.3 4.1 wks) groups (p>0.05).
3) All of 12 patients with persistent disease achieved complete remission regardless of prophylactic chemotherapy. There was no difference in the incidence of complete remission between both groups. In the treated group compared to the untreated, however, there were longer durations until the diagnosis of persistent disease (p<0.05) and more courses of chemotherapy required until complete remission (p<0.05).
4) Toxicities of the prophylactic chemotherapy developed in 79.5% of the patients treated with MTX-CF and in 62.5% of those with ACT-D. Frequent toxicities were nausea and vomiting (38.507o), epithelial (25.60/o), and hepatic ones (25.607o) in order. Especially heptaic toxicities were prominent in the high risk group compared to the low risk.
S) The frequencies of full term delivery in the patients with benign regression patterns of B-hCG were 62.907o and 40.9% in the treated and untreated groups, respectively, and 66.6% and 60.0% in the patients with persistent diseases, respectively. This indicates that the prophylactic chemotherapy has no influence oil the reproductive performance after molar pregnancy and persistent trophoblastic disease.
6) From the above results, it is believed that the prophylactic chemotherapy should be limited to the molar patients who have high risk factors or are expected to be missed in the follow-up instead of giving to all patients in our situation since the frequency of loss in follow-up has been much decreasing recently.
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