Hydatidiform Mole (HM) Management
Treatment of HM is within the purview of the obstetrician/gynecologist and will not be discussed separately here. However, following the diagnosis and treatment of HM, patients should be monitored to rule out the possibility of metastatic gestational trophoblastic neoplasia. In almost all cases, this can be performed with routine monitoring of serum beta human chorionic gonadotropin (beta-hCG) to document its return to normal. An effective form of contraception is important during the follow-up period to avoid the confusion that can occur with a rising beta-hCG as a result of pregnancy.
Chemotherapy is necessary when there is the following:
- A rising beta-hCG titer for 2 weeks (3 titers).
- A tissue diagnosis of choriocarcinoma.
- A plateau of the beta-hCG for 3 weeks.
- Persistence of detectable beta-hCG 6 months after mole evacuation.
- Metastatic disease.
- An elevation in beta-hCG after a normal value.
- Postevacuation hemorrhage not caused by retained tissues.
Chemotherapy is ultimately required for persistence or neoplastic transformation in about 15% to 20% of patients after evacuation of a complete HM but for fewer than 5% of patients with partial HM. Chemotherapy is determined by the patient's modified World Health Organization score.
In women with complete HM, risk of persistence or neoplastic transformation is approximately doubled in the setting of certain characteristics, which include the following:
- Age older than 35 years or age younger than 20 years.
- Pre-evacuation serum beta-hCG greater than 100,000 IU/L.
- Large-for-date uterus.
- Large uterine molar mass.
- Large (>6 cm) ovarian cysts.
- Hyperemesis of pregnancy.
- Trophoblastic embolization.
- Disseminated intravascular coagulation.
Studies have shown that a single course of prophylactic dactinomycin or methotrexate can decrease the risk of a postmolar gestational trophoblastic disease (GTD).[1-3] However, there is concern that chemoprophylaxis increases tumor resistance to standard therapy in the women who subsequently develop GTD. Therefore, this practice is generally limited to countries in which a large number of women do not return for follow-up.Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with hydatidiform mole. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.References
- Kim DS, Moon H, Kim KT, et al.: Effects of prophylactic chemotherapy for persistent trophoblastic disease in patients with complete hydatidiform mole. Obstet Gynecol 67 (5): 690-4, 1986. [PUBMED Abstract]
- Limpongsanurak S: Prophylactic actinomycin D for high-risk complete hydatidiform mole. J Reprod Med 46 (2): 110-6, 2001. [PUBMED Abstract]
- Uberti EM, Fajardo Mdo C, Ferreira SV, et al.: Reproductive outcome after discharge of patients with high-risk hydatidiform mole with or without use of one bolus dose of actinomycin D, as prophylactic chemotherapy, during the uterine evacuation of molar pregnancy. Gynecol Oncol 115 (3): 476-81, 2009. [PUBMED Abstract]