Role of surgical therapy in the management of gestational trophoblastic neoplasia

Abstract

ObjectiveTo evaluate the role of adjuvant surgical procedures in the management of gestational trophoblastic neoplasia (GTN).MethodsIn a retrospective review of medical records at the Severance Hospital, we identified 174 patients diagnosed with GTN between 1986 and 2006. Of the 174 patients, 129 (74%) were assigned to the nonmetastatic group, and 45 (26%) to the metastatic group; of the metastatic group patients, 6 were in the low-risk group and 39 were in the high-risk group. Thirty-two patients underwent 35 surgical procedures as part of the GTN treatment. The procedures included hysterectomy, lung resection, craniotomy, uterine wedge resection, uterine suturing for bleeding, salpingo-oophorectomy, pretherapy dilatation and curettage, adrenalectomy, nephrectomy, and uterine artery embolization.ResultsOf the 32 patients who underwent surgical procedures, 28 (87%) survived. Eleven patients underwent surgery for chemoresistant disease after receiving one or more chemotherapy regimens. Twelve patients underwent procedures to control tumor hemorrhage. Nine (81%) of 11 patients with chemoresistant disease survived, and 8 patients who underwent salvage surgery for chemoresistant disease received further chemotherapy. Of 21 patients who underwent hysterectomy, 19 (90%) achieved remission. All of three patients who had resistant foci of choriocarcinoma in the lung achieved remission through pulmonary resection.ConclusionAdjuvant surgical procedures, especially hysterectomy and pulmonary resection for chemoresistant disease, as well as procedures to control hemorrhage, are pivotal in the management of GTN.

Identification and treatment of gestational trophoblastic neoplasia located in the cesarean scar

“…The regimen to be used depends on the FIGO stage and classification. Although surgery is considered less important in the management of GTN, selected surgical procedures may be necessary to remove chemoresistant lesions in the uterus and metastatic sites and to control associated complications . In the present study, all patients received chemotherapy, which mainly comprised multidrug regimens.…”

“…Although surgery is considered less important in the management of GTN, selected surgical procedures may be necessary to remove chemoresistant lesions in the uterus and metastatic sites and to control associated complications. 13 In the present study, all patients received chemotherapy, which mainly comprised multidrug regimens. However, hysterectomy and localized uterine lesion resection were performed in as many as 71.0% of patients during chemotherapy because of chemoresistant lesions (Fig.…”

Gestational Trophoblastic Disease: Choriocarcinoma and Its Treatment

“…It is also used to evaluate the effectiveness of treatment and, in many cases, may be the only tangible parameter indicating trophoblastic disease. GTNs produce different forms of hCG and thus, it is crucial to precisely determine them (EOH et al, 2015;TEMPFER et al, 2016).…”

“…Chemotherapy is not required for low-risk patients who have undergone hysterectomy. Monitoring of hCG levels during and after treatment should be done according to the same standards used for molar diseases (LURAIN, 2011;BRAGA et al, 2014;STEVES et al, 2015;EOH et al, 2015;BOLZE et al, 2015).…”

Heterotopic pregnancy with molar changes

“…Angiographic embolization of the uterine arteries, instead of surgical intervention have been used to control bleeding. 11 Patients with GTN should have follow-up serum β-hCG levels measured once per week till nonpregnant values are reached then serum β-hCG levels should be obtained once per month for 1 year. Women with GTD should be advised to use barrier methods of contraception until β hCG levels become normal.…”