Management of Gestational Trophoblastic Disease

doi:10.1111/1471-0528.16266

Cited by 22 publications

(17 citation statements)

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“…However, it can sometimes lead to different treatments, in case the placental site trophoblastic tumour is diagnosed. Proceeding to a surgical evacuation of the uterus to confirm the diagnosis of choriocarcinoma is also associated with an increased risk of bleeding [2], as in our case, thus effective communication with the local gestational trophoblastic centre should be maintained.…”

Section: Discussionmentioning

confidence: 73%

“…However, the prognosis might be worse in cases of CC after non-molar pregnancy, probably due to delay in diagnosis or advanced disease [10]. The FIGO prognostic score is widely used to identify high-risk patients and guide treatment regimens [2]. Low-risk patients (FIGO 6 or less) are usually treated with single-agent chemotherapy (methotrexate), whereas high-risk patients (FIGO 7 or more) require polytherapy with etoposide, methotrexate, and dactinomycin being one of the most widely used treatment regimens.…”

Section: Discussionmentioning

confidence: 99%

“…Low-risk patients (FIGO 6 or less) are usually treated with single-agent chemotherapy (methotrexate), whereas high-risk patients (FIGO 7 or more) require polytherapy with etoposide, methotrexate, and dactinomycin being one of the most widely used treatment regimens. The cure rate after successful referral to a tertiary centre is 98-100% in the U.K [2]. High dose chemotherapy with stem cell recovery might be required in rare cases of multi-relapsed disease [11].…”

Section: Discussionmentioning

confidence: 99%

“…Collectively, the malignant forms are referred to as gestational trophoblastic neoplasia (GTN). The incidence of molar pregnancies (CHM/PHM) is reported to be 0.2-1.5 per 1000 births in Europe [1] and one in 714 in the U.K [2]. GTD in the majority of cases is related to molar pregnancies, and the incidence after a full-term pregnancy is rare.…”

Section: Introductionmentioning

confidence: 99%

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Choriocarcinoma After Full-Term Pregnancy: A Case Report and Review of the Literature

Katsanevakis¹,

Oatham²,

Mathew³

2022

Cureus

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Choriocarcinoma is a disease associated with uncontrollable proliferation and malignant change of cells of the placenta and belongs to the malignant end of the spectrum in gestational trophoblastic disease. These tumours are usually developed after molar pregnancies, and their incidence after full-term pregnancies is extremely rare.We present a very rare case of a 30-year-old lady, admitted with a five-month history of vaginal bleeding after a normal pregnancy. The human chorionic gonadotropin (hCG) was at a level of 209,566. A pelvic ultrasound scan revealed an endometrial thickness of 6 cm and the presence of an intra-uterine mass measuring 56 × 50 × 45 mm. After discussion with the regional gestational trophoblastic disease centre, we proceeded to a surgical evacuation of the uterus, which confirmed a post-partum choriocarcinoma (International Federation of Gynaecology and Obstetrics (FIGO) score 9). Care was continued in the specialised centre with multi-agent chemotherapy. The response was excellent, and the patient was subsequently discharged after 10 cycles of chemotherapy, and a 10-year follow-up was arranged.Choriocarcinomas after full-term pregnancies are a rare entity. Even when they happen, they are usually associated with pregnancy complications in the ante-natal period. The prognosis is usually very good, provided that prompt diagnosis and referral to a specialised centre are made. Low-risk patients are usually treated with methotrexate monotherapy, whereas high-risk women would normally require multi-agent chemotherapy.The diagnosis of choriocarcinoma might be proven challenging even for experienced clinicians. Women should be informed that the prognosis is usually excellent, provided that they receive the right treatment.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Choriocarcinoma After Full-Term Pregnancy: A Case Report and Review of the Literature

Katsanevakis¹,

Oatham²,

Mathew³

2022

Cureus

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“…Suspected vaginal metastatic lesions of GTD are prone to massive bleeding. Experts recommend avoiding biopsy, excision, or other surgery involving such lesions [ 10 , 11 ]. In our case, surgery was performed on the vaginal mass only to control the bleeding from suspected fragile tumor tissue, which had caused the hematoma.…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Early Transformation of Gestational Trophoblastic Neoplasia Following Molar Pregnancy

et al. 2021

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Patient: Female, 19-year-old Final Diagnosis: Gestational thropoblastic neoplasia Symptoms: Bleeding Medication:— Clinical Procedure: Curettage Specialty: Obstetrics and Gynecology • Oncology Objective: Rare disease Background: Gestational trophoblastic disease (GTD) encompasses a group of disorders that arise from abnormal growth of trophoblastic tissue. The spectrum of GTD includes 2 major groups: benign and malignant. The benign form is a hydatidiform mole, either complete or partial; the malignant forms, referred to as gestational trophoblastic neoplasia (GTN), consist of invasive moles, choriocarcinomas, placental site trophoblastic tumors, and epithelioid trophoblastic tumors. Most patients who undergo evacuation of a hydatidiform mole by curettage have a disease-free period before a new tumor develops that can be considered malignant. In rare cases, metastasis occurs rapidly and manifests coincidentally before the hydatidiform mole can be evacuated. Case Report: A 19-year-old woman in Bandung City, West Java, Indonesia, was diagnosed with a molar pregnancy with early evidence of a mass in her vagina that was suspicious for stage II GTN. The early emergence of a vaginal mass was a rare case of early transformation of a molar pregnancy into GTN. Conclusions: Careful evaluation is warranted of patients with characteristics typical of an intrauterine molar pregnancy who have an early presentation of a vaginal mass because of the possibility that the diagnosis could be GTN.

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PREDICT‐GTN 1: Can we improve the FIGO scoring system in gestational trophoblastic neoplasia?

Parker

Winter

Tidy

et al. 2022

Intl Journal of Cancer

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Gestational trophoblastic neoplasia (GTN) patients are treated according to the eight-variable International Federation of Gynaecology and Obstetrics (FIGO) scoring system, that aims to predict first-line single-agent chemotherapy resistance. FIGO is imperfect with one-third of low-risk patients developing disease resistance to first-line single-agent chemotherapy. We aimed to generate simplified models that improve upon FIGO. Logistic regression (LR) and multilayer perceptron (MLP) modelling (n = 4191) generated six models (M1-6). M1, all eight FIGO variables (scored data); M2, all eight FIGO variables (scored and raw data); M3, nonimaging variables (scored data); M4, nonimaging variables (scored and raw data); M5, imaging variables (scored data); and M6, pretreatment hCG (raw data) + imaging variables (scored data). Performance was compared to FIGO using true and false positive rates, positive and negative predictive values, diagnostic odds ratio, receiver operating characteristic (ROC) curves, Bland-Altman calibration plots, decision curve analysis and contingency tables. M1-6 were calibrated and outperformed FIGO on true positive rate and positive predictive value. Using LR and MLP, M1, M2 and M4 generated small improvements to the ROC curve and decision curve analysis. M3, M5 and M6 matched FIGO or performed less well. Compared to FIGO, most (excluding LR M4 and MLP M5) had significant discordance in patient classification (McNemar's test P < .05); 55-112 undertreated, 46-206 overtreated. Statistical modelling yielded only small gains over FIGO performance, arising through recategorisation of treatment-resistant patients, with a significant proportion of under/overtreatment a sthea vai la b led atah av ebe enu se dapri orito allocate primary chemotherapy. Streamlining FIGO should now be the focus.

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Management of Gestational Trophoblastic Disease

Abstract: Women who undergo medical abortion should be recommended to do a urinary pregnancy test 3 weeks after the procedure.

Cited by 22 publications

References 63 publications

Choriocarcinoma After Full-Term Pregnancy: A Case Report and Review of the Literature

Choriocarcinoma After Full-Term Pregnancy: A Case Report and Review of the Literature

A Rare Case of Early Transformation of Gestational Trophoblastic Neoplasia Following Molar Pregnancy

PREDICT‐GTN 1: Can we improve the FIGO scoring system in gestational trophoblastic neoplasia?

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