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Evidence summaries

Prophylactic Chemotherapy for Hydatidiform Mole to Prevent Gestational Trophoblastic Neoplasia

Prophylactic chemotherapy may reduce the risk of progression to gestational trophoblastic disease in women with complete hydatidiform mole compared with no treatment. Level of evidence: "C"

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).

Summary

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.

Clinical comments

Note

Date of latest search: 10 August 2012

    References

    • Wang Q, Fu J, Hu L et al. Prophylactic chemotherapy for hydatidiform mole to prevent gestational trophoblastic neoplasia. Cochrane Database Syst Rev 2017;(9):CD007289. [PubMed]

Primary/Secondary Keywords