Diagnosis, classification and treatment of gestational trophoblastic neoplasia

Abstract

Gestational trophoblastic neoplasia (GTN) is the term to describe a set of malignant placental diseases, including invasive mole, choriocarcinoma, placental site trophoblastic tumor and epithelioid trophoblastic tumor. Both invasive mole and choriocarcinoma respond well to chemotherapy, and cure rates are greater than 90%. Since the advent of chemotherapy, low-risk GTN has been treated with a single agent, usually methotrexate or actinomycin D. Cases of high-risk GTN, however, should be treated with multiagent chemotherapy, and the regimen usually selected is EMA-CO, which combines etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine. This study reviews the literature about GTN to discuss current knowledge about its diagnosis and treatment. ResumoNeoplasia trofoblástica gestacional (NTG) é o termo que descreve o conjunto de anomalias malignas da placenta, incluindo a mola invasora, coriocarcinoma, tumor trofoblástico do sítio placentário e tumor trofoblástico epitelióide. Ambos a mola invasora e o coriocarcinoma respondem bem à quimioterapia, com taxas de cura superiores a 90%. Desde o advento da quimioterapia, NTG de baixo risco tem sido tratada com monoquimioterapia, pelo geral methotrexate ou actinomicina-D. Casos de NTG de alto risco, contudo, devem ser tratados com poliquimioterapia, e o regime usualmente escolhido é o EMA-CO que combina etoposide, methotrexate, actinomicina-D, ciclofosfamida e vincristina. Esse estudo revê a literatura sobre NTG a fim de discutir os conhecimentos atuais sobre seu diagnóstico e tratamento.

Efficacy and Risk Factors Associated to Resistance to Single-Agent Chemotherapy in Low-Risk Gestational Trophoblastic Neoplasia

“…However, a consensus has been reached about the use of a single agent, such as MTX or ActD, for patients with low-risk disease. These drugs have induction remission rates of 50% to 90% [4].…”

“…In general, weekly IM or intermittent IV infusion of MTX and biweekly ActD are less effective than MTX and ActD for five days or MTX/FA for eight days. However, almost all patients are cured and have their fertility preserved despite the differences in initial remission after primary chemotherapy [4]. The weekly MTX 30 -50 mg/m 2 regimen has the advantage of convenience and low cost and toxicity, but has the lowest complete response rate among all other regimens [4].…”

Treatment of low-risk gestational trophoblastic neoplasia comparing biweekly eight-day Methotrexate with folinic acid versus bolus-dose Actinomycin-D, among Brazilian women

“…FIGO stage and score were retrospectively determined in patients treated prior to 2002. Complete response or remission was diagnosed after 3 consecutive weekly hCG levels were within normal range (<5 mIU/mL) and sustained remission, when the hCG level remained at that same level for 1 year 1,2,4,5,7,18 . Our management protocol is shown in Figure 1.…”

“…Most GTD cases include the two types of hydatidiform moles (HM) that have a variable potential to progress into the rare malignant disease, called gestational trophoblastic neoplasia (GTN) 2,3 . GTN has become a highly curable tumor, with an overall 90% of patient survival, due to the possibility of early diagnosis and treatment monitoring, ideally in Reference Centers (RC), and the individualized chemotherapy (ChT) based on prognostic factors, according scoring system of the International Federation of Gynecology and Obstetrics (FIGO) 2002 [1][2][3][4][5][6][7] . The FIGO 2002 defined that low-risk GTN could be treated with single-agent ChT, resulting in final survival rates approaching 100% 3,7 .…”

Trends of Gestational Trophoblastic Disease at a Tertiary Care Hospital

“…2,3 GTN is among rare human tumours that can be cured, with an overall 90% of patient survival, due to the inherent chemotherapy sensitivity of trophoblastic neoplasms, the effective use of the tumour marker beta human chorionic gonadotrophin (βhCG) for diagnosis of disease and monitoring of therapy and the identification of prognostic factors that enhances individualization of chemotherapy. [1][2][3][4][5][6][7] The objective of this study was to determine the clinical presentation of GTD and response of GTN to single and multiple agent chemotherapy on the basis of WHO Prognostic risk scoring system.…”