Treating gestational trophoblastic disease

Rodriguez, Noah; Goldstein, Donald P.; Berkowitz, Ross S.

doi:10.1517/14656566.2010.512288

Cited by 9 publications

(7 citation statements)

References 66 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our institution, some surgical interventions are used to control complications such as hysterectomy for bleeding complication and some surgical interventions are used to remove the resistant foci. The reason for surgical intervention in this study is correlated to previous reviews (Lurain et al, 1995;Patel et al, 2010;Rodriguez et al, 2010). Multimodality treatment can improve overall survival of resistant GTN patients (Lurain, 2011;Osborne et al, 2012).…”

Section: Discussionsupporting

confidence: 81%

Treatment of Extremely High Risk and Resistant Gestational Trophoblastic Neoplasia Patients in King Chulalongkorn Memorial Hospital

Oranratanaphan

Lertkhachonsuk²

2014

Asian Pacific Journal of Cancer Prevention

View full text Add to dashboard Cite

Section: Discussionsupporting

confidence: 81%

Treatment of Extremely High Risk and Resistant Gestational Trophoblastic Neoplasia Patients in King Chulalongkorn Memorial Hospital

Oranratanaphan

Lertkhachonsuk²

2014

Asian Pacific Journal of Cancer Prevention

View full text Add to dashboard Cite

“…The high cure rate after hysterectomy in our LR non-metastatic group may be attributed to the prophylactic use of 1-2 courses of MTX/FA with hysterectomy in most participating centres in this study. Rodriguez et al also supported this concept [23]. The role of hysterectomy in the LR metastatic group is less clear; Eysbouts et al reported that no cases with metastatic GTN achieved remission with hysterectomy alone [24].…”

Section: Discussionmentioning

confidence: 97%

Prognosis of Gestational Trophoblastic Neoplasia in Women at 40 Years Old and Above: A Multicentre Retrospective Study

Hemida¹,

Sauthier²,

Toson³

et al. 2020

COR

View full text Add to dashboard Cite

Purpose: To investigate the outcome of different treatment strategies in patients with gestational trophoblastic neoplasia (GTN) in women at 40 years old and above. Patients and Methods: We analysed a historical cohort from 5 referral centres from 5 countries, including all women with GTN treated between 2012 and 2017, who were 40 years old and older. Baseline characteristics and outcome of different treatment strategies were recorded and evaluated. The patients were categorized into low-risk non-metastatic, low-risk metastatic and high-risk, based on the FIGO classification. Results: A total of 141 cases were identified, of which 112 cases fulfilled the inclusion criteria. Mean age was 45.4 years ± 4.2SD. Of 80 patients with LR non-metastatic GTN, 46 women received single agent chemotherapy and 34 a hysterectomy with or without (n = 4) chemotherapy. Higher remission rate and shorter treatment duration (P=0.001) was seen in the group that underwent hysterectomy. Seven of the 14 patients with low-risk, metastatic GTN were cured with methotrexate. Two of the 18 high risk patients died before treatment, four were treated with polychemotherapy; two of them needed second line chemotherapy for incomplete response. Two cases received induction with methotrexate followed by EMA/CO. Ten highrisk patients were treated with hysterectomy and chemotherapy, of these six achieved complete remission, three needed second line chemotherapy, and one patient died during chemotherapy treatment. Conclusion: In this cohort of women with GTN at 40 years old or above, we found high proportions of metastatic and high-risk cases, of methotrexate resistance, and of need for multiple treatment lines. In all groups, hysterectomy was performed, but its role remains controversial in metastatic low-risk and high-risk disease.

show abstract

“…In addition, Fleming et al found that patients who survived after thoracotomy for GTN were likely to have: A) perioperative hCG less than 1500 mIU/mL; B) stage III disease (no liver or brain metastases); and C) solitary pulmonary nodule [22]. Several investigators have reported that the achievement of non-detectable hCG within 1-2 weeks after resection of a solitary pulmonary nodule is highly predictive of favorable outcome [2,19]. Cao et al reported that the patients with chemotherapy-resistant GTN who received more than four regimens or 13 cycles of pre-operative chemotherapy had a poor prognosis and were less likely to benefit from pulmonary lobectomy [26].…”

Section: Surgical Managementmentioning

confidence: 99%

“…Patients with GTN are classified as having low-risk or high-risk disease using the modified World Health Organization prognostic scoring system, that is adapted by the International Federation of Gynecology and Obstetrics (FIGO). High-risk is defined by FIGO stage IV or any FIGO stage with a score ≥7, which indicates multi-agent chemotherapies as standard therapy [2,3].…”

Section: Introductionmentioning

confidence: 99%

Management of EMA-CO resistant/refractory gestational trophoblastic neoplasia

Babaier¹,

Jim²,

Ghatage³

2018

Cancer Rep Rev

View full text Add to dashboard Cite

The majority of gestational trophoblastic neoplasia (GTN) responds extremely well to first-line, multiagent chemotherapy employing etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMA-CO). However, up to 30% of patients develop either resistance or recurrence. Although EMA-CO resistant GTN is a relatively rare disease, it can be challenging to manage. The cure rate to such a condition is highly dependent on the availability of an effective multiagent chemotherapy regimen with reasonable toxicity profile. Close monitoring of high-risk patients, early diagnosis and recognition is key for a successful outcome. Despite the primary role of chemotherapy in EMA-CO resistant disease, surgical interventions have been shown to improve survival and cure rate. A variety of multiagent chemotherapy regimens have shown efficacy in EMA-CO resistant disease. Unfortunately, to date, there is no strong evidence to suggest which regimen is the standard second-line therapy. Many patients require multiple regimens with or without surgery to achieve complete remission. Early and appropriate intervention is crucial to maximize the chance of cure. The aim of this review article is developing a comprehensive clinical guide for management of EMA-CO resistant GTN.

show abstract

Treating gestational trophoblastic disease

Abstract: GTN is highly responsive to chemotherapy. However, surgery is an important adjunct in select cases. Even in advanced-stage or recurrent disease, cure can be achieved and fertility preserved.

Cited by 9 publications

References 66 publications

Treatment of Extremely High Risk and Resistant Gestational Trophoblastic Neoplasia Patients in King Chulalongkorn Memorial Hospital

Treatment of Extremely High Risk and Resistant Gestational Trophoblastic Neoplasia Patients in King Chulalongkorn Memorial Hospital

Prognosis of Gestational Trophoblastic Neoplasia in Women at 40 Years Old and Above: A Multicentre Retrospective Study

Management of EMA-CO resistant/refractory gestational trophoblastic neoplasia

Contact Info

Product

Resources

About