Feasibility of central co-ordinated EMA/CO for gestational trophoblastic disease in the Netherlands.

Objective: In the Netherlands, high risk gestational trophoblastic disease (GTD) patients are treated in different referral hospitals with a national working party on trophoblastic tumours having a co-ordinating function. Our purpose was to evaluate whether this policy is a satisfactory alternative to complete centralisation.

Design: A retrospective study of all etoposide, methotrexate, actomycin D, cyclophosphamide and vincristine (EMA/CO)-treated women in the Netherlands between 1986 and 1997. Data regarding risk factors, treatment results and toxicity were collected.

Setting: Ten hospitals; 2 general, 6 academical and 2 oncology centres.

Population: Fifty EMA/CO-treated women registered by the central registration unit of the Dutch Working Party on Trophoblastic Disease.

Methods: Patients files and quarterly reports of the Dutch Working Party.

Main Outcome Measures: Cure rate and consistency of treatment in different hospitals.

Results: EMA/CO treatment was administered in 10 different hospitals. All patients were discussed during the meetings of the Dutch Working Party and overall, 86% of patients were cured. Consistency in treatment was good.

Conclusions: Cure rates were comparable with results of single institution series. We conclude that treatment of high risk GTD patients in different referral hospitals with concentration of expertise in a working party is a good alternative to centralisation of treatment in GTD specialised hospitals.