PT  - JOURNAL ARTICLE
AU  - Yohann Dabi
AU  - Touria Hajri
AU  - Jérôme Massardier
AU  - Mélodie Mathé
AU  - Benoît You
AU  - Jean-Pierre Lotz
AU  - Sophie Patrier
AU  - Yassemine Khawajkie
AU  - Anne Marie Schott
AU  - François Golfier
AU  - Pierre-Adrien Bolze
TI  - Outcome of First-Line Hysterectomy for Gestational Trophoblastic Neoplasia in Patients No Longer Wishing to Conceive and Considered With Isolated Lung Metastases: A Series of 30 Patients
AID  - 10.1097/IGC.0000000000001367
DP  - 2018 Nov 01
TA  - International Journal of Gynecologic Cancer
PG  - 1766--1771
VI  - 28
IP  - 9
4099  - http://ijgc.bmj.com/content/28/9/1766.short
4100  - http://ijgc.bmj.com/content/28/9/1766.full
SO  - Int J Gynecol Cancer2018 Nov 01; 28
AB  - Objective This study aimed to assess the outcome of first-line hysterectomy in patients diagnosed as having gestational trophoblastic neoplasia (GTN) whose postoperative imaging showed lung images considered as metastases.Methods From 1999 to 2016, patients no longer wishing to conceive, treated by their initial physician by hysterectomy, and whose postoperative imaging workup showed lung images considered as metastasis were identified in the French Trophoblastic Disease Reference Center database. We sought to identify significant predictive factors of requiring salvage chemotherapy.Results Thirty patients were identified with a maximum number of 2 visible lung nodules and a median largest size of 14 mm on chest x-ray. Nine of these patients had an International Federation of Gynecology and Obstetrics score of higher than 6, and there were no postterm GTN. Twenty-two patients (73.33%; 95% confidence interval, 54.11–87.72; P = 0.0053) normalized their human chorionic gonadotropin (hCG) without salvage chemotherapy, whereas 7 received 1 line of salvage monochemotherapy (8-day methotrexate) and 1 required 2 lines of monochemotherapy (5-day actinomycin D after failure of methotrexate). After a 12.45-month median follow-up (range, 3–48.4 months) since the first normalized hCG, none of these patients died. The median interval between successful hysterectomy and hCG normalization was 3.15 months (range, 1.6–8.7 months). Patients who required salvage chemotherapy had a median size of the largest lung metastasis on chest computed tomography of 4 mm larger than those cured by hysterectomy (P = 0.0455).Conclusions For GTN patients no longer wishing to conceive with lung metastases discovered postoperatively, treated by hysterectomy, and whose hCG is decreasing, it is reasonable to expect and to inform patients that approximately 27% will require salvage chemotherapy. However, in patients with lung metastases discovered preoperatively, evidence to recommend first-line hysterectomy is insufficient and these patients should receive first-line chemotherapy.