Gestational Trophoblastic Disease: A Study of Mode of Evacuation and Subsequent Need for Treatment with Chemotherapy

Tidy, John; Gillespie, Alan; Bright, N.; Radstone, C. R.; Coleman, Robert L.; Hancock, Barry W.

doi:10.1006/gyno.2000.5839

Cited by 87 publications

(44 citation statements)

References 7 publications

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“…Tidy and associates retrospectively compared different methods of molar evacuation, reporting that medical induction was associated with higher rates of chemotherapy for postmolar GTN [4]. They attributed this effect to higher rates of incomplete evacuation than with suction D&E. Additionally, Schlaerth et al [5] reported that the rates of significant hemorrhage and incomplete evacuation were higher after induction of labor than after D&E. Furthermore, all but one of their patients ultimately required suction D&E after induction of labor to complete the evacuation [6].…”

Section: Induction Of Labormentioning

confidence: 99%

“…Selective angiographic localization and embolization techniques have been used to conservatively manage hemorrhage from active sites of metastatic GTN and to treat intrauterine arteriovenous malformations that can occasionally develop after treatment of GTN [4]. Grumbine et al [48] reported prophylactic placement of a catheter in the hepatic artery for balloon occlusion or embolization in the event of rupture in a patient with liver metastases of GTN.…”

Section: Ancillary Proceduresmentioning

confidence: 99%

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The Role of Surgery and Radiation Therapy in the Management of Gestational Trophoblastic Disease

Hanna

Soper

2010

The Oncologist

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After completing this course, the reader will be able to:1. Describe the indications for surgical intervention in the management of patients with hydatidiform moles and malignant GTN in order to choose patients most likely to benefit from these interventions.2. Discuss the use of radiation in the management of patients with malignant GTN and consider its use as an adjunct to chemotherapy or surgery.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTThe primary management of hydatidiform moles remains surgical evacuation followed by human chorionic gonadotropin level monitoring. Although suction dilatation and evacuation is the most frequent technique for molar evacuation, hysterectomy is a viable option in older patients who do not wish to preserve fertility. Despite advances in chemotherapy regimens for treating malignant gestational trophoblastic neoplasia, hysterectomy and other extirpative procedures continue to play a role in the management of patients with both lowrisk and high-risk gestational trophoblastic neoplasia. Primary hysterectomy can reduce the amount of chemotherapy required to treat low-risk disease, whereas surgical resections, including hysterectomy, pulmonary resections, and other extirpative procedures, can be invaluable for treating highly selected patients with persistent, drug-resistant disease. Radiation therapy is also often incorporated into the multimodality therapy of patients with high-risk metastatic disease. This review discusses the indications for and the role of surgical interventions during the management of women with hydatidiform moles and malignant gestational trophoblastic neoplasia and reviews the use of radiation therapy in the treatment of women with malignant gestational trophoblastic neoplasia. The Oncologist 2010;15: 593-600Correspondence: John T. Soper, M.D., CB 7852, B110 Physicians Office Building,

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Section: Induction Of Labormentioning

confidence: 99%

Section: Ancillary Proceduresmentioning

confidence: 99%

The Role of Surgery and Radiation Therapy in the Management of Gestational Trophoblastic Disease

Hanna

Soper

2010

The Oncologist

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“…The management of such pregnancies creates a dilemma for the physician and parents, particularly when PHMCF occurs during the second trimester of pregnancy. Medical termination is effective during the second trimester; however, this technique increases the risk of the occurrence of PTD when used to terminate molar pregnancies (7). The aim of this study was to investigate the safety of medical termination for patients with PHMCF.…”

Section: Introductionmentioning

confidence: 99%

“…The empirical management of pregnancy in the second trimester is more difficult (10). Suction curettage is the typical treatment for females exhibiting molar pregnancy, however normal fetal structures may preclude the use of this method (7). Medical induction of labor is an effective and safe way for the termination of normal pregnancies during the second trimester (21).…”

mentioning

confidence: 99%

“…However, medical termination of molar pregnancy is associated with an increased risk of a subsequent requirement for chemotherapeutic treatment, due to the development of increased intrauterine pressure in the first and second trimesters (7). Performance of a caesarean section is not recommended during the second trimester of pregnancy, due to the increased risk of maternal morbidity and the fact that the reduced gestational period means that the neonate is too small to survive (7).…”

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confidence: 99%

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Medical termination of a partial hydatidiform mole and coexisting fetus during the second trimester: A case report

2015

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Abstract. Partial hydatidiform mole and coexisting fetus (PHMCF) is a rare condition that presents a dilemma for physicians and the parents of the fetus, particularly when PHMCF is detected during the second trimester of pregnancy. The present study reports a case of PHMCF terminated by induction of labor via administration of Rivanol at 17 weeks. Follow-up measurements of serum β-human chorionic gonadotropin (β-HCG) levels, as well as imaging studies, indicated the presence of persistent trophoblastic disease (PTD) and lung metastases. The patient was therefore admitted for three courses of chemotherapy. Subsequently, the metastases receded and β-HCG levels decreased to within the normal range. The patient demonstrated no disease recurrence for 1 year. Following a review of the relevant literature, to the best of our knowledge, all PHMCF cases terminated by medical induction of labor during the second trimester resulted in the development of PTD and lung metastases. However, three cases of PHMCF that were terminated by caesarean section during the third trimester did not develop PTD or metastases. The present study therefore hypothesized that medical termination may not be a safe therapeutic strategy for the treatment of PHMCF during the second trimester, and that pregnancy should be allowed to continue empirically.

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