Abstract
Background: Gestational trophoblastic neoplasia (GTN), despite its widespread metastases, is a very common cancer in women that is curable. Although the GTN cases show a good response to chemotherapy, in an effort to reduce toxic drug exposure, the second curettage has been suggested for some patients. In the current study, we have aimed to compare the benefits of the second curettage in comparison with single-agent chemotherapy for low-risk GTN patients.
 
 Methods: This retrospective observational study was carried out on GTN patients admitted to the gynecology department of Imam Khomeini Hospital in Ahvaz. The demographic profile of all participants was extracted. Patients' hospitalization records were also extracted from the files. Patients with an endometrial thickness above 10 mm were treated with re-curettage. The β hCG clearance time was estimated by the Kaplan Meier plot. 
 
 Results: In the present study, 148 patients with low-risk GTN stage 1 were studied. The time required for β-hCG clearance in patients undergoing re-curettage was significantly lower than the chemotherapy receiving group (7 months vs. 10 months, p <0.0001). More than 50% of patients treated by re- curettage without needing chemotherapy. Moreover, the other 50% cases needed chemotherapy the number of courses was significantly lower than those received single-agent chemotherapy alone (p <0.0001). The baseline β-hCG levels were significantly lower in those who did not need chemotherapy (p = 0.012). β-hCG resolution occurred more rapidly in patients undergoing re-curettage alone, while, those who received only chemotherapy had a longer duration for β-hCG clearance.
 
 Conclusion: In general, the findings of this study showed that re-curettage could be used effectively in the treatment of GTN following molar pregnancy. This treatment reduces or eliminates the need for chemotherapy. Our findings also showed that the initial level of β-hCG could be considered as a predictive factor in response to curettage.
Highlights
Gestational trophoblastic diseases (GTD) include a variety of diseases during pregnancy that are commonly associated with abnormal trophoblastic proliferation and ranged from benign hydatidiform mole to malignant choriocarcinoma
The Gestational trophoblastic neoplasia (GTN) cases show a good response to chemotherapy, in an effort to reduce toxic drug exposure, the second curettage has been suggested for some patients (Pezeshki et al, 2004)
Patients were divided into two groups as those receiving chemotherapy and re-curettage
Summary
Gestational trophoblastic diseases (GTD) include a variety of diseases during pregnancy that are commonly associated with abnormal trophoblastic proliferation and ranged from benign hydatidiform mole to malignant choriocarcinoma. In the cases of low risk GTN the total scores obtained from the FIGO scoring system is less than 7 It is calculated based on the age of diagnosis-based, previous pregnancy outcome, interpregnancy interval, β-hCG serum level, the largest tumor size (uterus or metastasis, metastasis site, number of the identified metastases and number of drugs in previously failed chemotherapy) (Committee, 2002; van Trommel, Massuger, Verheijen, Sweep, & Thomas, 2005). The time required for β-hCG clearance in patients undergoing re-curettage was significantly lower than the chemotherapy receiving group (7 months vs 10 months, p
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