Gestational trophoblastic neoplasia and evidence-based medicine.

OBJECTIVE

To determine whether protocols for the management of gestational trophoblastic neoplasia conform to the principles of evidence-based medicine.

STUDY DESIGN

Protocols for the management of low- and high-risk gestational trophoblastic neoplasia were examined to determine to what extent they conformed to the principles of evidence-based medicine.

RESULTS

Nearly all current chemotherapy regimens for gestational trophoblastic neoplasia are based on the experience of management of various risk groups, variously defined. Some prospective, randomized studies were flawed by faulty selection criteria. Local population variations may influence the results of management.

CONCLUSION

The management of trophoblastic neoplasia is based on physician experience. Nearly all prospective, randomized studies have been flawed. There is a need for carefully planned prospective studies with stringent inclusion criteria to determine the most effective and cost-effective and least toxic therapy, particularly for low-risk neoplasia.