RESUMO
OBJECTIVE: To compare the effect of high-dose vitamin A (HD Vit-A) use during postmolar follow-up of patients with low and plateauing (L&P) serum human chorionic gonadotropin (hCG) levels, from the moment serum hCG plateaued (P-hCG) to the first normal serum hCG value (< 5 IU/L). METHODS: The present retrospective series case study compared two nonconcurrent cohorts of patients. Control group (CG): 34 patients with L&P serum hCG levels who underwent expectant management for 6 months after uterine evacuation, from 1992 to 2010; study group (SG): 32 patients in similar conditions who received 200,000 IU of Vit-A daily, from the identification of a P-hCG level to the first normal hCG value or the diagnosis of progression to gestational trophoblastic neoplasia (GTN), from 2011 to 2017. The present study was approved by the Ethics Committee of the institution where it was conducted. RESULTS: In both groups, the prevalence of persistent L&P serum hCG levels was < 5%. In the SG, hCG levels at plateau were higher (CG = 85.5 versus SG = 195 IU/L; p = 0.028), the rate of postmolar GTN was lower (CG = 29.4% versus SG = 6.3%, p = 0.034) and follow-up was shorter (CG = 14 versus SG = 10 months, p < 0.001). During GTN follow-up, there were no differences in GTN staging or treatment aggressiveness in both groups. High-dose Vit-A use did not have any relevant toxic effect. There were no GTN relapses or deaths. CONCLUSION: The limited use of HD Vit-A seems to have a safe and significant effect on the treatment of postmolar patients with L&P serum hCG levels and may decrease the development of postmolar GTN in this population.
OBJETIVO: Comparar o efeito de alta dose de vitamina A (VitA) no seguimento pós-molar de pacientes com gonadotrofina coriônica humana (hCG) sérica apresentando valores baixos e em platô (L&P). MéTODOS: Estudo retrospectivo de série de casos comparando duas coortes não simultâneas. Grupo controle (CG): 34 pacientes com títulos de hCG sérico L&P submetidos a manejo expectante por 6 meses após o esvaziamento uterino, de 1992 a 2010; Grupo de Estudo (SG): de 2011 a 2017, 32 pacientes em condições semelhantes de hCG receberam Vit-A na dose de 200.000 IU por dia, do momento da identificação do hCG em platô ate o primeiro hCG normal ou diagnóstico de progressão para neoplasia trofoblástica gestacional (NTG). O presente estudo foi aprovado pelo Comitê de Ética da Instituição na qual foi desenvolvido. RESULTADOS: Em ambos os grupos, a prevalência de hCG L&P foi < 5%. No SG, os níveis de hCG em platô foram maiores (CG = 85.5 versus SG = 195 IU/L; p = 0,028), e foram significantemente menores tanto a prevalência de NTG pós-molar (CG = 29.4% versus SG = 6.3%, p = 0,034) como o tempo de seguimento (CG = 14 versus SG = 10 meses, p < 0.001). Na evolução para NTG não houve diferença no estadiamento da International Federation of Gynecology and Obstetrics (FIGO, na sigla em inglês) ou na agressividade do tratamento. Com altas doses de Vit-A não houve qualquer efeito tóxico relevante. Não houve casos de recidiva de NTG ou de óbito. CONCLUSãO: O uso limitado de altas doses de Vit-A parace ser seguro e apresenta efeitos significativos na evolução de pacientes em controle pós-molar com títulos de hCG sérico L&P, e pode diminuir o desenvolvimento de NTG pós-molar nessa população.
Assuntos
Gonadotropina Coriônica/sangue , Mola Hidatiforme/sangue , Neoplasias Uterinas/sangue , Vitamina A/uso terapêutico , Adolescente , Adulto , Biomarcadores Tumorais/sangue , Feminino , Doença Trofoblástica Gestacional/prevenção & controle , Humanos , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Vitamina A/administração & dosagem , Adulto JovemRESUMO
Abstract Objective To compare the effect of high-dose vitamin A (HD Vit-A) use during postmolar follow-up of patients with low and plateauing (L&P) serum human chorionic gonadotropin (hCG) levels, from the moment serum hCG plateaued (P-hCG) to the first normal serum hCG value (< 5IU/L). Methods The present retrospective series case study compared two nonconcurrent cohorts of patients. Control group (CG): 34 patients with L&P serum hCG levels who underwent expectant management for 6 months after uterine evacuation, from 1992 to 2010; study group (SG): 32 patients in similar conditions who received 200,000 IU of Vit-A daily, from the identification of a P-hCG level to the first normal hCG value or the diagnosis of progression to gestational trophoblastic neoplasia (GTN), from 2011 to 2017. The present study was approved by the Ethics Committee of the institution where it was conducted. Results In both groups, the prevalence of persistent L&P serum hCG levels was < 5%. In the SG, hCG levels at plateau were higher (CG = 85.5 versus SG = 195 IU/L; p = 0.028), the rate of postmolar GTN was lower (CG = 29.4% versus SG = 6.3%, p = 0.034) and follow-up was shorter (CG = 14 versus SG = 10 months, p < 0.001). During GTN follow-up, there were no differences in GTN staging or treatment aggressiveness in both groups. High-dose Vit-A use did not have any relevant toxic effect. There were no GTN relapses or deaths. Conclusion The limited use of HD Vit-A seems to have a safe and significant effect on the treatment of postmolar patients with L&P serum hCG levels and may decrease the development of postmolar GTN in this population.
Resumo Objetivo Comparar o efeito de alta dose de vitamina A (VitA) no seguimento pósmolar de pacientes com gonadotrofina coriônica humana (hCG) sérica apresentando valoresbaixoseem platô(L&P). Métodos Estudo retrospectivo de série de casos comparando duas coortes não simultâneas. Grupo controle (CG): 34 pacientes com títulos de hCG sérico L&P submetidos a manejo expectante por 6 meses após o esvaziamento uterino, de 1992 a 2010; Grupo de Estudo (SG): de 2011 a 2017, 32 pacientes em condições semelhantes de hCG receberam Vit-A na dose de 200.000 IU por dia, do momento da identificação dohCG em platôate o primeirohCG normaloudiagnóstico de progressão para neoplasia trofoblástica gestacional (NTG). O presente estudo foi aprovado pelo Comitê de Ética da Instituição na qual foi desenvolvido. Resultados Em ambososgrupos, aprevalência de hCGL&P foi < 5%. No SG, os níveis de hCGemplatô forammaiores (CG = 85.5 versus SG = 195 IU/L; p = 0,028), e foram significantemente menores tanto a prevalência de NTG pós-molar (CG = 29.4% versus SG = 6.3%, p = 0,034) como o tempo de seguimento (CG = 14 versus SG = 10 meses, p < 0.001). Na evolução para NTG não houve diferença no estadiamento da Interna tional Federation of Gynecology and Obstetrics (FIGO, na sigla em inglês) ou na agressividade do tratamento. Com altas doses de Vit-A não houve qualquer efeito tóxico relevante. Não houve casos de recidiva de NTG ou de óbito. Conclusão O uso limitado de altas doses de Vit-A parace ser seguro e apresenta efeitos significativos na evolução de pacientes em controle pós-molar com títulos de hCG sérico L&P, e pode diminuir o desenvolvimento de NTG pós-molar nessa população.
Assuntos
Humanos , Feminino , Gravidez , Adolescente , Adulto , Adulto Jovem , Neoplasias Uterinas/sangue , Vitamina A/uso terapêutico , Mola Hidatiforme/sangue , Gonadotropina Coriônica/sangue , Vitamina A/administração & dosagem , Biomarcadores Tumorais/sangue , Estudos Retrospectivos , Resultado do Tratamento , Doença Trofoblástica Gestacional/prevenção & controle , Pessoa de Meia-IdadeRESUMO
Introducción: numerosas investigaciones se han dedicado a estudiar la Enfermedad Trofoblástica Gestacional, al indagar en sus particularidades y demostrar como puede la misma evolucionar tanto satisfactoriamente, como dar al traste con la vida de la paciente; se hace énfasis en la importancia de su diagnóstico y tratamiento precoz, con el afán de disminuir las tasas de incidencia, de recidivas y/o complicaciones.Objetivo: Evaluar la evolución clínica de pacientes con ETG atendidas en el Hospital Ginecobstétrico Ramón González Coro entre los años 2008-2012.Métodos: la investigación se desarrolló en el Hospital Ginecobstétrico Ramón González Coro en el año 2013. Se realizó un estudio observacional descriptivo transversal, se consultaron 47 bibliografías y se trabajó con 18 historias clínicas de pacientes que cumplieron con los criterios de inclusión. No se aplicó ninguna técnica de muestreo pues utilizó el universo.Resultados: la mayoría de los casos fueron pacientes con más de 24 años. No existieron hallazgos sobre la relación del color de la piel con la enfermedad en cuestión. Predominó como motivo de ingreso el sangramiento vaginal, y al examen con espéculo el principal signo fue la salida de sangre por el orificio cervical externo. Casi el total de la muestra presentó un útero aumentado de tamaño. Más de la mitad de los casos fueron diagnosticados como Mola Hidatiforme Parcial(AU)
Introduction: endometrial hyperplasia is a proliferation of endometrial glands in size and irregular shape, caused by excessive exposure to estrogen. Objective: to characterize the endometrial hyperplasia in patients at Eusebio Hernßndez Hospital in 2011. Method: a descriptive study was conducted. 2842 pathology reports were reviewed in the Department of Pathology, at Profesor Eusebio Hernández Gynecobstetric Hospital in Marianao, Havana from January 1st to December 31st, 2011. 1269 of them were for endometrial biopsies obtained by curettage. Results: 154 endometrial biopsies (12.1 percent) had the diagnosis of endometrial hyperplasia. The age range of diagnosis was more frequent for women between 41 and 50 years and the highest percentage of patients (84.4 percent) were diagnosed with simple hyperplasia without atypia; while 7.1 percent of the cases showed atypia. The associated risk factor was obesity in 46.1 percent of cases. Ultrasound had positivity in patients with atypical endometrial 90.9 percent and 100 percent hysteroscopy. Hormone therapy was used in 67.5 percent of patients and surgical treatment was used in all patients with cellular atypia. Conclusions: there was a predominance of endometrial hyperplasia without atypia in women aged between 41 and 60 and with low parity and a low occurrence of atypical hyperplasia(AU)
Assuntos
Humanos , Feminino , Gravidez , Doença Trofoblástica Gestacional/diagnóstico , Doença Trofoblástica Gestacional/prevenção & controle , Doença Trofoblástica Gestacional/patologia , Epidemiologia Descritiva , Estudos Transversais , Estudos Observacionais como AssuntoRESUMO
OBJECTIVE: To evaluate the efficacy of actinomycin D (Act-D) as prophylactic chemotherapy (P-Chem) to reduce postmolar gestational trophoblastic neoplasia (GTN) in patients with high-risk hydatidiform mole (Hr-HM). METHODS: From 1987 to 2006, 265 Hr-HM were selected in a retrospective analysis of a nonrandomized clinical trial of 1090 patients with gestational trophoblastic disease (GTD) followed up at a Trophoblastic Disease Center (TDC) in southern Brazil. From 1996 to 2006, 163 received a single bolus dose of Act-D at time of uterine evacuation (Hr-HM-chem group); 102 with the same risk factors did not get P-Chem (Hr-HM-control group). Variables were: number of patients with postmolar GTN who required chemotherapy during follow-up, postmolar GTN morbidity, compliance and operational costs. RESULTS: Postmolar GTN was diagnosed in 18.4% of the Hr-HM-chem patients (95% CI: 12.7-24.7) and in 34.3% of the Hr-HM-control patients (95% CI: 25.1-43.5). Postmolar GTN was 46% lower in P-Chem (RR=0.54; 95% CI: 0.35-0.82; NNT=7). P-Chem adverse effects were occasional and minor. When disease progressed to postmolar GTN, severity was the same, but costs were lower for the Hr-HM-chem group. Compliance with follow-up was high and similar in both groups. CONCLUSIONS: Follow-up of patients with Hr-HM showed that a single bolus dose of prophylactic Act-D reduced the incidence of postmolar GTN. Compliance and postmolar GTN morbidity were not affected. Treatment costs and emotional complications were reduced. This prophylactic approach can be adopted before uterine evacuation in any TDC that treats Hr-HM patients that present with undelivered moles.
Assuntos
Antibióticos Antineoplásicos/uso terapêutico , Dactinomicina/uso terapêutico , Doença Trofoblástica Gestacional/prevenção & controle , Mola Hidatiforme/tratamento farmacológico , Adulto , Antibióticos Antineoplásicos/efeitos adversos , Dactinomicina/efeitos adversos , Feminino , Doença Trofoblástica Gestacional/patologia , Humanos , Mola Hidatiforme/patologia , Mola Hidatiforme/cirurgia , Gravidez , Estudos RetrospectivosRESUMO
OBJECTIVE: To evaluate the efficacy of a single prophylactic dose of actinomycin D (Act-D) in the reduction of postmolar gestational trophoblastic neoplasia (GTN) in adolescents with high-risk hydatidiform mole (Hr-HM). METHODS: In a retrospective study, 60 adolescents with Hr-HM were selected from a cohort of patients with gestational trophoblastic disease (GTD) followed at Santa Casa, Porto Alegre, Brasil. Twenty-nine received a single dose of Act-D at the time of uterine evacuation as prophylactic chemotherapy (P-chem) (study group) and 31 patients with the same risk factors did not received P-chem (control group). Patient follow-up was the same in both groups. Each group was analyzed for number of adolescents with postmolar GTN, morbidity associated with postmolar GTN, and reproductive outcomes. RESULTS: Postmolar GTN was diagnosed in two (6.9%) adolescents (95% CI, 0.0-16.1) in the study group and in 9 (29.0%) patients (95% CI, 13-45) in the control group. The reduction of postmolar GTN with a single dose of Act-D used as P-chem was 76% (relative risk = 0.24; 95% CI, 0.06-0.99). Adverse effects of P-chem were minor. In the follow-up, when postmolar GTN were diagnosed, severity of disease was not increased, compliance with follow-up was not reduced, and reproductive outcomes after discharge were similar. CONCLUSIONS: P-chem with a single dose of Act-D reduced postmolar GTN in 76% during follow-up of adolescents with Hr-HM. Since this regimen may reduce treatment costs, without affecting compliance with follow-up, it can be adopted by any Trophoblastic Disease Center.