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BMJ 2011; 343 doi: (Published 06 December 2011) Cite this as: BMJ 2011;343:d7882

Who needs chemotherapy after evacuation of molar pregnancy?

Most women with molar pregnancies are cured after uterine evacuation. A minority need chemotherapy when residual disease undergoes malignant transformation, and identifying these women is an ongoing challenge that often depends on concentrations of human chorionic gonadotrophin (HCG) in serum or urine. When concentrations stay high or get higher after evacuation, consensus guidelines recommend chemotherapy. More controversially, they also recommend chemotherapy for women whose HCG concentrations are falling, but just not fast enough. A retrospective look at a series of 76 women who had a uterine evacuation at one hospital in the UK suggests they may not have needed chemotherapy.

The only indication for chemotherapy in these women was a concentration of HCG in blood or urine that failed to fall below normal limits within six months. Sixty six of the women opted to continue surveillance without chemotherapy, and concentrations returned to normal in 65, usually within a year of a uterine evacuation. Slightly high concentrations endured for more than 18 months in one patient on haemodialysis for end stage renal failure. She did not develop trophoblastic neoplasia.

The 10 women who opted for chemotherapy (methotrexate and folinic …

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