Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment, blinding, and incomplete outcome data in 2/3 studies) and by imprecise results (few patients and outcome events).
A Cochrane review [Abstract] 1 included 3 studies with a total of 613 subjects. One study compared prophylactic dactinomycin to no prophylaxis; the other two studies compared prophylactic methotrexate to no prophylaxis. All participants were diagnosed with complete hydatidiform moles. Prophylactic chemotherapy reduced the risk of gestational trophoblastic neoplasia (GTN) (RR 0.37; 95% CI 0.24 to 0.57; 3 trials, n=550). However, excluding the 2 poor quality studies, only one small study of dactinomycin in high-risk women contributed data for this primary outcome of GTN (RR 0.28; 95% CI 0.10 to 0.73; P = 0.01, n=59).There were insufficient data to perform meta-analyses for toxicity, overall survival, drug resistance and reproductive outcomes.
Date of latest search: 10 August 2012
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