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.