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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.
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) 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 Each group was analyzed for P-chem (P-chem) (study group) and 31 patients with the same risk factors did not receive P-chem (control group). Patient follow-up was the same in both groups. 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 (95% CI, 13-45) in the control group. The reduction of postmolar GTN wi In a few doses of Act-D used as P-chem was 76% (relative risk = 0.24; 95% CI, 0.06-0.99). 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.