Adjuvant hysterectomy in low-risk gestational trophoblastic disease

Objective: To evaluate the efficacy of adjuvant hysterectomy with chemother apy for women with low-risk gestational trophoblastic disease. Methods: One hundred fifteen consecutive Japanese women (16-52 years old) w ith low-risk gestational trophoblastic disease (46 with metastatic disease and 69 without) were treated initially with single-agent chemotherapy (etop oside in 85, methotrexate in 27, and actinomycin D in three) with or withou t adjuvant hysterectomy, and 97 patients (84.3%) achieved primary remission with those treatments. Eight women (9.4%) treated with etoposide required other regimens because of drug resistance or toxicities. The total dose of etoposide given to achieve primary remission was analyzed in 77 women who r eceived etoposide alone or with adjuvant hysterectomy. Results: In 34 women with metastatic disease, the mean (+/- standard deviat ion [SDI]) total dose of etoposide was not significantly different with and without adjuvant hysterectomy (2857 +/- 842 mg versus 2815 +/- 815 mg; P = .957; Mann-Whitney U test). However, in 43 women without metastases, the t otal dose of etoposide was significantly less in those who had adjuvant hys terectomies than in those who did not (1750 +/- 635 mg versus 2545 +/- 938 mg; P < .05; Mann-Whitney U test). Conclusion: Adjuvant hysterectomy decreased the total dose of etoposide giv en to achieve primary remission in women with nonmetastatic, low-risk gesta tional trophoblastic disease. If the lesions of gestational trophoblastic d isease are confined to the uterus and the woman has no desire to preserve f ertility, she should be informed of adjuvant hysterectomy as a treatment op tion. (C) 2001 by The American College of Obstetricians and Gynecologists.