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

BJOG. 2004 Feb;111(2):143-7. doi: 10.1046/j.1471-0528.2003.00039.x.


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.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Cyclophosphamide / administration & dosage
  • Dactinomycin / administration & dosage
  • Etoposide / administration & dosage
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Methotrexate / administration & dosage
  • Middle Aged
  • Pregnancy
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome
  • Trophoblastic Neoplasms / drug therapy*
  • Uterine Neoplasms / drug therapy*
  • Vincristine / administration & dosage


  • Dactinomycin
  • Vincristine
  • Etoposide
  • Cyclophosphamide
  • Methotrexate