Early detection of persistent trophoblastic tumour by serum human chorionic gonadotrophin monitoring after molar pregnancy.

OBJECTIVE

To study the outcome of a multi-centred post-molar pregnancy serum human chorionic gonadotrophin (hCG) surveillance programme.

METHODS

Patients recruited into the multi-centred post-molar serum hCG surveillance programme between 1988 and 1996 were studied. The clinical data were obtained from medical records and computer database.

RESULTS

There were 616 patients in the study. Twenty-five (11%) of 224 patients with molar pregnancy and 28 (7%) of 392 patients with partial molar pregnancy were diagnosed to have persistent trophoblastic tumour (PTT) requiring chemotherapy. Of the 53 patients treated for PTT, 58.5% received intravenous methotrexate (MTX), 22.6% received both MTX and actinomycin D, and 19% received CHAMOC, a multiple chemotherapeutic regimen. Four patients receiving single drug had to change the regimen because of poor response, and all recovered and remained well. There were 3 cases of recurrence, one in each group of patients receiving single, dual or multiple agents. One patient died because of treatment complication. The rest were well with a mean follow-up of 42 months.

CONCLUSIONS

Post-molar serum hCG surveillance is important to detecting persistent trophoblastic activity. Early treatment of PTT by the appropriate chemotherapy has a near hundred percent cure and prevents the progression of PTT into more advanced trophoblastic malignancy such as choriocarcinoma.