It seems reasonable, though the present author´s 24 cases are too short to draw any definite conclusion, that the more logical treatment for the hydatidiform mole is the prophylactic hysterectomy or curettage with additional chemotherapy, rather than the conservative management with careful follow-up only following curettage which was practiced in general until now.
Reviewing the references concerned, it was presumed that three factors, socioeconomic status, older age and higher parity, should be claimed for the main responsibility of higher incidence of hydatidiform mole and particularly in this country higher rate of malignant change.
The prophylactic hysterectomy seems therefore, to be the more reasonable resort for the patient of older age and who has enough children though still young and chemotherapy after curettage is justified for those, who are of younger age of desire more off-spring. Also were made the references about the theoretical basis of methotrexate action as a chemotherapeutic agent on the trophoblastic tumor.
With the policy of treatment above-described, the following results were obtained. All of the patient underwent the hysterectomy (13 cases) and all of chemotherapy after curettage (4 cases) resulted in complete healing with no evidence of chorionic malignancies. The result of curettage without chemotherapy was followed in a case by biologic pregnancy test and physical examination. The follow-up of the rest 6 cases were impossible.
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