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Outcome of First-Line Hysterectomy for Gestational Trophoblastic Neoplasia in Patients No Longer Wishing to Conceive and Considered With Isolated Lung Metastases: A Series of 30 Patients

Dabi, Yohann, MD*; Hajri, Touria, MSc†‡; Massardier, Jérôme, MD†§; Mathé, Mélodie, MD§; You, Benoît, MD, PhD†∥¶; Lotz, Jean-Pierre, MD, PhD†#; Patrier, Sophie, MD†**; Khawajkie, Yassemine, MSc††; Schott, Anne Marie, MD, PhD; Golfier, François, MD, PhD†‡‡; Bolze, Pierre-Adrien, MD†‡‡

International Journal of Gynecological Cancer: November 2018 - Volume 28 - Issue 9 - p 1766–1771
doi: 10.1097/IGC.0000000000001367
Gestational Throphoblastic Neoplasia

Objective This study aimed to assess the outcome of first-line hysterectomy in patients diagnosed as having gestational trophoblastic neoplasia (GTN) whose postoperative imaging showed lung images considered as metastases.

Methods From 1999 to 2016, patients no longer wishing to conceive, treated by their initial physician by hysterectomy, and whose postoperative imaging workup showed lung images considered as metastasis were identified in the French Trophoblastic Disease Reference Center database. We sought to identify significant predictive factors of requiring salvage chemotherapy.

Results Thirty patients were identified with a maximum number of 2 visible lung nodules and a median largest size of 14 mm on chest x-ray. Nine of these patients had an International Federation of Gynecology and Obstetrics score of higher than 6, and there were no postterm GTN. Twenty-two patients (73.33%; 95% confidence interval, 54.11–87.72; P = 0.0053) normalized their human chorionic gonadotropin (hCG) without salvage chemotherapy, whereas 7 received 1 line of salvage monochemotherapy (8-day methotrexate) and 1 required 2 lines of monochemotherapy (5-day actinomycin D after failure of methotrexate). After a 12.45-month median follow-up (range, 3–48.4 months) since the first normalized hCG, none of these patients died. The median interval between successful hysterectomy and hCG normalization was 3.15 months (range, 1.6–8.7 months). Patients who required salvage chemotherapy had a median size of the largest lung metastasis on chest computed tomography of 4 mm larger than those cured by hysterectomy (P = 0.0455).

Conclusions For GTN patients no longer wishing to conceive with lung metastases discovered postoperatively, treated by hysterectomy, and whose hCG is decreasing, it is reasonable to expect and to inform patients that approximately 27% will require salvage chemotherapy. However, in patients with lung metastases discovered preoperatively, evidence to recommend first-line hysterectomy is insufficient and these patients should receive first-line chemotherapy.

*Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Faculté de médecine de Créteil UPEC—Paris XII, Créteil;

French Center for Trophoblastic Diseases, University Hospital Lyon Sud, Pierre Bénite;

Pôle Information Médicale Evaluation Recherche, Equipe d’Accueil 4129, Hospices Civils de Lyon, Lyon;

§Department of Obstetrics and Gynecology, University of Lyon 1, University Hospital Femme Mere Enfant, Bron;

Department of Medical Oncology, HCL Cancer Institute, University Hospitals of Lyon, Lyon;

Lyon 1 University, EA 3738;

#Department of Medical Oncology, Alliance For Cancer Research, Tenon Hospital, Public Assistance Hospitals of Paris (AP-HP), Paris;

**Department of Pathology, University Hospital of Rouen, Rouen, France;

††Division of Experimental Medicine, McGill University Health Centre, Montreal, Quebec, Canada; and

‡‡University of Lyon 1, University Hospital Lyon Sud, Department of Gynecological Surgery and Oncology, Obstetrics, Pierre Bénite, France.

Address correspondence and reprint requests to Pierre Adrien Bolze, MD, Centre Français des Maladies Trophoblastiques, Centre Hospitalier Lyon Sud, 165, Chemin du Grand Revoyet, Bâtiment 3B, 2ème étage, 69495 Pierre Bénite, France. E-mail: pierre-adrien.bolze@chu-lyon.fr.

The French Center for Trophoblastic Diseases was funded by the French Ligue Nationale contre le Cancer and the Institut National du Cancer.

The authors declare no conflict of interest.

Received February 19, 2018

Received in revised form July 21, 2018

Accepted August 20, 2018

© 2018 by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology.