Introduction/Background Increasing maternal age is a known risk factor of developing molar pregnancy and the progression to gestational trophoblastic neoplasia (GTN); however, its treatment in women aged 40 years and above is poorly studied.

To the best of our knowledge; this is the first prospective study to investigate treatment of GTN at 40 years or older.

Methodology A prospective, non-randomized clinical trial was conducted. It included eighteen women who were diagnosed as low-risk GTN at 40 years and above and were managed at the GTD clinic, Mansoura University hospitals for 2 years from January, 2020 to December, 2022. The decision of treatment was taken according to tumor board recommendations. The remission rate, number of chemotherapy courses, duration of treatment, and complications were compared between the two groups.

Results Ten cases (55.6%) received methotrexate/folinic acid regimen, all of them achieved remission. Hysterectomy plus one course of methotrexate/folinic was performed in 8 out of 18 cases (44.4%). Seven of them (87.5%) achieved remission while one case (12.5%) developed chemoresistance and shifted to EMA/CO combination. Duration of treatment till normalization of Β-HCG was shorter in the hysterectomy group (7 versus 9 weeks) yet, it was not statistically significant. Mean number of chemotherapy courses per case for both groups were (1.63 versus 3.1 respectively); which was not significant (P=0.22). No statistically significant difference in number of treatment complications in both groups. No reported relapse during first year of follow up in both groups. No reported mortalities among the studied cases.

Conclusion No significant difference between performing upfront hysterectomy with single-agent chemotherapy and primary chemotherapy as regards, remission, duration of treatment, number of chemotherapy courses, and rate of complications for GTN patients at 40 years or older. A larger randomized-controlled study should be conducted to assess the best strategy for treatment of this age group.

Disclosures No conflict of interests.