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Prevention of Gestational Trophoblastic Disease by Use of Actinomycin D in Molar Pregnancies

From the New England Trophoblastic Disease Center, Department of Obstetrics and Gynecology, Harvard Medical School; The Trophoblastic Tumor Service, Boston Hospital for Women (Lyingin Division); and The Brigham-Harvard Reproductive Biology Unit, Boston, Massachusetts

Abstract

Actinomycin D, 12 µg/kg/day, for 5 consecutive days, was administered intravenously to 100 patients with molar pregnancy at the time of evacuation. A comparable group of 100 patients with molar pregnancy untreated at the time of evacuation was used as control. Proliferativc trophoblastic sequelae occurred in 2 patients in the treated group, in contrast to 16 patients in the untreated group. No cases of mctastatic trophoblastic disease (MTD) were encountered in the treated group, but 4 cases of MTD developed in untreated patients. Druginduced toxicity in the treated group was mild and transient. The use of actinomycin D prophylactically at the time of evacuation of molar pregnancy appears to eliminate MTD and substantially reduce the incidence of nonmetastatic trophoblastic disease (NMTD) with a wide margin of safety. Despite the safety and effectiveness of this technic, its use should be limited to special situations where the risk of developing trophoblastic disease is greater than normal or where adequate gonadotropin followup is unavailable.