Effects of Prophylactic Chemotherapy on Persistent Trophoblastic Diseases and Post-evacuation Serum Human Chorionic Gonadotrophic Hormone Regression in the Patients with Complete Hydatidiform Mole

Abstract

Objective To ascertain basic clinical information, the benefit and pitfall of Actinomycin D prophylactic chemotherapy in high risk complete hydatidiform mole with pre-evacuation serum beta hCG (human chorionic gonadotrophic hormone) over 200,000 mlU/mL, and the effect of prophylactic chemotherapy on post-evacuation serum beta hCG regression.

Subjects An analysis of 156 patients with complete hydatidiform mole admitted to Rajavithi Hospital between 1990-1995.

Results Around fifty-four percent of patients who sought medical services at Rajavithi Hospital domiciled in distant provinces. Fifty-two percent had complete their compulsory education ; 40 percent had received education beyond the compulsory level, 2.8 percent were illiterate. Records were not complete for the remaining 5.2 percent. Eighty-one patients who had regular post-evacuation follow up were recruited for evaluation. Actinomycin D was administered to thirty-one patients who had pre-evacuation serum beta hCG over 200,000 mIU/mL (treated group). The other group of twenty-two patients with serum beta hCG over 200,000 mIU/mL served as the control (untreated group). Nineteen percent of the treated group (6 out of 31) developed GTT compared with 31.8 percent (7 out of 22) in the untreated group, which was not statistically significant (P = 0.3446, 2-tail Fisher's exact). Neither severe drug toxicity nor death occurred in this study. Only 2 out of 28 or 7.1 percent of the group with serum beta hCG less than 200,000 mlU/mL had persistent disease.

Conclusion If selective Actinomycin D prophylaxis was given to the patients with complete hydatidiform mole at Rajavithi Hospital with the condition of serum beta hCG over 200,000 mlU/mL, the incidence of GTT would be 13.6 percent. If no chemoprophylaxis was administered to this group of patients, the incidence of GTT could be expected to be 18 percent. Actinomycin D prophylaxis, while not