Upfront Hysterectomy Versus Primary Chemotherapy in the Management of Low-Risk Gestational Trophoblastic Neoplasia at Old Age Patients: A Prospective Study

To compare the outcome of hysterectomy plus single-agent chemotherapy and primary chemotherapy in treatment of low-risk gestational trophoblastic neoplasia (GTN) at 40 years old and above.

A prospective, non-randomized clinical trial was conducted. It included eighteen women with low-risk GTN at 40 years and above, who were managed at the GTD clinic, Mansoura University hospitals, for 2 years from first of January 2020 to end of December 2021. The decision of treatment was taken according to tumour board recommendations. The remission rate, number of chemotherapy courses, duration of treatment, and complications were compared between the two groups.

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 was found. No reported relapse during the first year of follow-up in both groups was found. No reported mortalities among the studied cases was found.

No significant difference between performing 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 was found.