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

Learning Objectives After completing this course, the reader will be able to: 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. 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 The 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 low‐risk 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.