One hundred and eighty-nine patients with molar pregnancy were studied prospectively in order to evaluate the effectiveness of prophylactic chemotherapy in preventing trophoblastic disease. In 73 patients, evacuation was carried out with the adjunctive use of Methotrexate, 0.3 mg/kg/day (20 patients), actinomycin D, 9 μg/kg/day (20 patients), and actinomycin D, 12 μg/kg/day (33 patients) for five days with evacuation generally on the third day. The remaining 116 patients served as controls. Suction curettage was used for evacuation, replacing abdominal hysterotomy in virtually all patients regardless of uterine size. Histopathologic grading of the molar specimen and endometrial curettings proved of some value in distinguishing those patients more likely to develop trophoblastic sequelae when the histologic grading exceeded Group III. A sensitive HCG test was a reliable means for following patients after evacuation. The prophylactic administration of Methotrexate or actinomycin D appeared to eliminate MTD and significantly reduce the incidence of NMTD. Actinomycin D at a dose level of 12 μg/kg/day was found to be the drug of choice. Toxic side effects were minimal The use of Methotrexate was associated with significant hepatotoxicity.
展开▼
