The role of repeat uterine evacuation in the management of persistent gestational trophoblastic disease

Pezeshki, Mohammad Zakaria; Hancock, Barry W.; Silcocks, P.; Everard, J; Coleman, James M.; Gillespie, Alan; Tidy, John; Coleman, RE

doi:10.1016/j.ygyno.2004.08.045

Cited by 81 publications

(59 citation statements)

References 7 publications

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“…Moreover, if the hCG exceeds 100 000 IU l À1 and the uterine mass is large, the potential benefit of a second evacuation is very small and the risks of haemorrhage and perforation increase. Similar findings have been reported by others (Pezeshki et al, 2004).…”

supporting

confidence: 93%

The management and outcome of women with post-hydatidiform mole ‘low-risk’ gestational trophoblastic neoplasia, but hCG levels in excess of 100 000 IU l−1

et al. 2010

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Background: Gestational trophoblastic neoplasia (GTN) after a hydatidiform mole is either treated with single- or multi-agent chemotherapy determined by a multifactorial scoring system. Women with human chorionic gonadotrophin (hCG) levels >100 000 IU l −1 can remain within the low-risk/single-agent category and usually choose one drug therapy. Here we compare the success and duration of single- vs multi-agent chemotherapy in this patient group. Methods: Between 1980 and 2008, 65 women had a pre-treatment hCG >100 000 IU l −1 and were low risk. The initial hCG level, treatment regimens, changes and duration and overall survival were recorded. Results: Of 37 patients starting low-risk/single-agent treatment, 11 (29.7%) were treated successfully, whereas 26 (70.3%) required additional multi-agent chemotherapy to achieve complete remission (CR). Combination chemotherapy was initially commenced in 28 women, and 2 (7%) required additional drugs for CR. The overall duration of therapy for those commencing and completing single- or multi-agent chemotherapy was 130 and 123 days ( P =0.78), respectively. The median-treatment duration for patients commencing single-agent but changing to multi-agent chemotherapy was 13 days more than those receiving high-risk treatment alone (136 vs 123 days; P =0.07). All 3 patients with an initial hCG >400 000 IU l −1 and treated with single-agent therapy developed drug resistance. Overall survival for all patients was 100%. Conclusion: Low-risk post-molar GTN patients with a pre-treatment hCG >100 000 and <400 000 IU l −1 can be offered low-risk single-agent therapy, as this will cure 30%, is relatively non-toxic and only prolongs treatment by 2 weeks if a change to combination agents is required. Patients whose hCG is >400 000 IU l −1 should receive multi-agent chemotherapy from the outset.

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supporting

confidence: 93%

The management and outcome of women with post-hydatidiform mole ‘low-risk’ gestational trophoblastic neoplasia, but hCG levels in excess of 100 000 IU l−1

et al. 2010

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“…A retrospective study found that 9,4% of women undergoing a second uterine evacuation did not need ChT to attain remission 23 . Benefits seem to be greater when hCG concentration is below 1500 IU/L at the time of evacuation 24 . However, this recommendation is controversial, and prospective randomized studies should be conducted to confirm the benefits of a repeat uterine evacuation.…”

Section: Low-risk Diseasementioning

confidence: 98%

Diagnosis, classification and treatment of gestational trophoblastic neoplasia

Biscaro¹,

Braga²,

Berkowitz³

2015

Rev. Bras. Ginecol. Obstet.

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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.

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“…Schlaerth and associates reported an 8.1% incidence of uterine perforation during the secondary D&E among 37 patients who underwent a secondary curettage during the course of treatment for postmolar GTN [21]. Uterine perforations or blood loss Ͼ1,000 ml occurred in 4.8% of the 85 patients in the series reported by van Trommel et al [22], whereas no significant acute complications were reported by Pezeshki et al [23]. No study to date has investigated the long-term incidence of uterine senechiae after a second D&E.…”

Section: Pretherapy Dandementioning

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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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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The role of repeat uterine evacuation in the management of persistent gestational trophoblastic disease

Cited by 81 publications

References 7 publications

The management and outcome of women with post-hydatidiform mole ‘low-risk’ gestational trophoblastic neoplasia, but hCG levels in excess of 100 000 IU l−1

The management and outcome of women with post-hydatidiform mole ‘low-risk’ gestational trophoblastic neoplasia, but hCG levels in excess of 100 000 IU l−1

Diagnosis, classification and treatment of gestational trophoblastic neoplasia

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

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