Treatment of persistent trophoblastic disease later than 6 months after diagnosis of molar pregnancy

Of 4257 patients with gestational trophoblastic disease (GTD) registered be tween 1986 and 1996 with the Trophoblastic Screening and Treatment Centre, Sheffield, 231 women required chemotherapy; 28 were treated 24 weeks or mor e after the initial evacuation of products of conception. In 18 patients la te treatment was a result of a predetermined watch and wait policy on the p art of the Centre; these patients formed the study group. Patients were ide ntified from the Centre's computer database. The time interval from first e vacuation (diagnosis) to start of chemotherapy was calculated for each pati ent. Hospital records were reviewed when the interval of observation was 24 weeks or greater to determine patient characteristics, treatment and outco me. Eighteen women were treated 'late' (according to Centre policy), with a median age of 30 years (range 21-57 years). The interval from diagnosis to treatment ranged from 24 to, in one case, 56 weeks (median 33 weeks). Four teen of 18 women had complete moles, 3/18 had partial moles and one had unc lassified disease. All women had low-risk disease and were treated with sin gle-agent methotrexate; 17 were cured with this regimen, one also required salvage chemotherapy. In conclusion, where a successful surveillance progra mme is in operation for GTD, a wait and watch policy can be adopted without compromising patients whose definitive treatment is commenced more than 6 months after the initial diagnosis. (C) 2000 Cancer Research Campaign.