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PREVENTION DES FORMES MALIGNES DE LA MALADIE TROPHOBLASTIQUE APRES UNE MOLE HYDATIFORME: CHIMIOTHERAPIE SYSTEMATIQUE OU CHIMIOTHERAPIE SELECTIVE?

par Delvoye, Pierre ;Robyn, Claude
Référence Journal de gynécologie obstétrique et biologie de la reproduction, 4, 2, page (267-293)
Publication Publié, 1975

Article révisé par les pairs

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Résumé :

After a mole has been evacuated, there are two ways of treating the condition: routine chemotherapy from the beginning, or chemotherapy reserved for selected cases. They offer the same chances of cure. Seeing that the risk of malignancy is 5 per cent and that selective chemotherapy only exposes a small number of patients to the risk of such treatment, the scheme of followup suggested by Bagshawe and recommended by the European Organization for Research on the Treatment of Cancer was adopted. The followup is based on radioimmunoassay for HCG, carried out at regular intervals for two years. Only cases where the level of HCG is higher than 25,000 international units per litre, one month after curettage, or cases where high levels of HCG persist six months after the mole has been evacuated, and cases where the rise in HCG is associated with metastases are treated with chemotherapy. In the authors' experience, which is based on 20 cases, the value of radioimmunoassay was confirmed. It is superior in sensitivity to immunological tests used for pregnancy diagnosis. It also appears that systematic treatment routinely administered and treatment based on raised levels of HCG two months after evacuation of a mole are useless. Only 3 cases were treated with chemotherapy out of 20 cases that were followed up. No malignancy was noted after 2 and 3 years of checking back on the patients. Treatment given routinely from the start would thus have constituted unnecessary exposure to the risks of chemotherapy for 17 patients. Had the abnormal rise in HCG after 8 weeks been considered, 7 patients instead of 3 would still have been treated with the same results with respect to cure. A graph was drawn for the drop in the levels of HCG after a mole has been evacuated. This may serve as the base of criteria for treatment in the future. Cases where the levels of HCG are above the 95 percentile are considered as at risk for evolution into malignant forms of disease. Consequently, earlier treatment can be started (before the 6th month) without altering the number of patients who are going to be treated.