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CC BY 4.0 · Rev Bras Ginecol Obstet 2020; 42(05): 240-247
DOI: 10.1055/s-0040-1710302
Original Article
Obstetrics
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Evaluation of High-Dose Vitamin A Treatment in Postmolar Patients with Low and Plateauing Serum Human Chorionic Gonadotropin Levels[*]

Avaliação de alta dose de Vitamina A em pacientes pós-mola hidatiforme, com valores baixos e em platô de gonadotrofina coriônica humana
Elza Maria Hartmann Uberti 
1   Porto Alegre Trophoblastic Disease Center, Mario Totta Maternity Ward, Hospital Irmandade da Santa Casa de Misericórdia, Porto Alegre, RS, Brazil
,
Ruth Karina Escobar Diaz 
1   Porto Alegre Trophoblastic Disease Center, Mario Totta Maternity Ward, Hospital Irmandade da Santa Casa de Misericórdia, Porto Alegre, RS, Brazil
,
Rodrigo Bernardes Cardoso 
1   Porto Alegre Trophoblastic Disease Center, Mario Totta Maternity Ward, Hospital Irmandade da Santa Casa de Misericórdia, Porto Alegre, RS, Brazil
,
Antonio Braga 
2   Rio de Janeiro Gestational Trophoblastic Disease Reference Center, Department of Obstetrics and Gynecology, Maternity School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
› Author Affiliations
Further Information

Publication History

09 June 2019

09 March 2020

Publication Date:
29 May 2020 (online)

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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 (< 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.

Resumo

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.

Keywords

gestational trophoblastic disease - low-and-plateauing serum hCG levels - high-dose vitamin A

Palavras-chave

doença trofoblástica gestacional - níveis de hCG sérico baixos e em “plateau” - alta dose de vitamina A

Contributions

All authors have contributed to the conception, design, data collection, analysis and interpretation, article essay and final approval of the text version to be published.


* Study conducted at the Trophoblastic Disease Center of ISCMPA, Porto Alegre, Brazil, and was presented at the XIX Biannual World Congress of the International society of the Study of Trophoblastic Diseases (ISSTD), September 21-24, 2017, Amsterdam.


 

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