Single-dose actinomycin D: Efficacy in the prophylaxis of postmolar gestational trophoblastic neoplasia in adolescents with high-risk hydatidiform mole.

Abstract

OBJECTIVE:

To evaluate the efficacy of a single prophylactic dose of actinomycin D (Act-D) in the reduction of postmolar gestational trophoblastic neoplasia (GTN) in adolescents with high-risk hydatidiform mole (Hr-HM).

METHODS:

In a retrospective study, 60 adolescents with Hr-HM were selected from a cohort of patients with gestational trophoblastic disease (GTD) followed at Santa Casa, Porto Alegre, Brasil. Twenty-nine received a single dose of Act-D at the time of uterine evacuation as prophylactic chemotherapy (P-chem) (study group) and 31 patients with the same risk factors did not received P-chem (control group). Patient follow-up was the same in both groups. Each group was analyzed for number of adolescents with postmolar GTN, morbidity associated with postmolar GTN, and reproductive outcomes.

RESULTS:

Postmolar GTN was diagnosed in two (6.9%) adolescents (95% CI, 0.0-16.1) in the study group and in 9 (29.0%) patients (95% CI, 13-45) in the control group. The reduction of postmolar GTN with a single dose of Act-D used as P-chem was 76% (relative risk = 0.24; 95% CI, 0.06-0.99). Adverse effects of P-chem were minor. In the follow-up, when postmolar GTN were diagnosed, severity of disease was not increased, compliance with follow-up was not reduced, and reproductive outcomes after discharge were similar.

CONCLUSIONS:

P-chem with a single dose of Act-D reduced postmolar GTN in 76% during follow-up of adolescents with Hr-HM. Since this regimen may reduce treatment costs, without affecting compliance with follow-up, it can be adopted by any Trophoblastic Disease Center.

• Authors: E M H Uberti, M C F Diestel, F E Guimarães, G De Nápoli, H Schmid
• Journal: Gynecologic oncology (Gynecol Oncol) Vol. 102 Issue 2 Pg. 325-32 (Aug 2006) ISSN: 0090-8258 [Print] United States
• PMID: 16476471 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antibiotics, Antineoplastic
• Dactinomycin

Topics

• Adolescent
• Adult
• Antibiotics, Antineoplastic (therapeutic use)
• Cohort Studies
• Dactinomycin (therapeutic use)
• Female
• Follow-Up Studies
• Gestational Trophoblastic Disease (prevention & control)
• Humans
• Hydatidiform Mole (surgery)
• Pregnancy
• Reproduction
• Retrospective Studies