Current Chemotherapeutic Management of Patients with Gestational Trophoblastic Neoplasia

Abstract

Gestational trophoblastic neoplasia (GTN) describes a heterogeneous group of interrelated lesions that arise from abnormal proliferation of placental trophoblasts. GTN lesions are histologically distinct, malignant lesions that include invasive hydatidiform mole, choriocarcinoma, placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor (ETT). GTN tumors are generally highly responsive to chemotherapy. Early stage GTN disease is often cured with single-agent chemotherapy. In contrast, advanced stage disease requires multiagent combination chemotherapeutic regimens to achieve a cure. Various adjuvant surgical procedures can be helpful to treat women with GTN. Patients require careful followup after completing treatment and recurrent disease should be aggressively managed. Women with a history of GTN are at increased risk of subsequent GTN, hence future pregnancies require careful monitoring to ensure normal gestational development. This article will review the workup, management and followup of women with all stages of GTN as well as with recurrent disease.

Trends of Gestational Trophoblastic Disease at a Tertiary Care Hospital

“…For nearly all low risk GTN patients, single agent chemotherapy with either MTX or Act-D is the preferred treatment. 1,2,5,7,20 A variety of regimens have been developed, in which non-randomized, mostly retrospective studies demonstrate a 50-90% chance of inducing remissiion. 21 Multiple agent chemotherapy should be used primarily in all high risk GTN patients.…”

“…1 Most of the GTD cases include two types of hydatidiform moles (HM) that have a variable potential to progress into the rare malignant disease gestational trophoblastic neoplasia (GTN). 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.…”

Trophoblastic Hyperthyroidism and Its Perioperative Concerns

“…The abnormal proliferation of trophoblastic tissue in the developing human placenta results in the condition known as Gestational Trophoblastic Neoplasia [1,2]. Gestational Trophoblastic Neoplasia lesions are histologically distinct malignant lesions that include hydatidiform mole, choriocarcinoma, placental site trophoblastic tumour and epithelioid trophoblastic tumour.…”

“…The highest incidence is in Philippines being 1 in 80 pregnancies and lowest in European countries, North America,Australia and New Zealand [6,10]. In the United States,hydatidiform moles are observed in approximately 1in 600 therapeutic abortions and 1 in 1000-2000 pregnancies [2,11]. The incidence in India is about 1 in 400 pregnancies [12].…”

“…(fig 5) Distant metastases can occur to lungs(70%), anterior vaginal wall(50%), brain(10%) and others [6]. Treatment is done with- [2,6] 1. Cytotoxic drugs.…”