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Update on the diagnosis and management of gestational trophoblastic disease
Author(s) -
Ngan Hextan Y.S.,
Seckl Michael J.,
Berkowitz Ross S.,
Xiang Yang,
Golfier François,
Sekharan Paradan K.,
Lurain John R.,
Massuger Leon
Publication year - 2018
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.12615
Subject(s) - medicine , molar pregnancy , human chorionic gonadotropin , gestational trophoblastic disease , chemotherapy , stage (stratigraphy) , disease , trophoblastic neoplasm , radiation therapy , pregnancy , gestational trophoblastic neoplasia , obstetrics , oncology , gynecology , gestation , hormone , biology , paleontology , genetics
Gestational trophoblastic disease ( GTD ) arises from abnormal placenta and is composed of a spectrum of premalignant to malignant disorders. Changes in epidemiology of GTD have been noted in various countries. In addition to histology, molecular genetic studies can help in the diagnostic pathway. Earlier detection of molar pregnancy by ultrasound has resulted in changes in clinical presentation and decreased morbidity from uterine evacuation. Follow‐up with human chorionic gonadotropin ( hCG ) is essential for early diagnosis of gestational trophoblastic neoplasia ( GTN ). The duration of hCG monitoring varies depending on histology type and regression rate. Low‐risk GTN ( FIGO Stages I– III : score <7) is treated with single‐agent chemotherapy but may require additional agents; although scores 5–6 are associated with more drug resistance, overall survival approaches 100%. High‐risk GTN ( FIGO Stages II – III : score >7 and Stage IV ) is treated with multiple agent chemotherapy, with or without adjuvant surgery for excision of resistant foci of disease or radiotherapy for brain metastases, achieving a survival rate of approximately 90%. Gentle induction chemotherapy helps reduce early deaths in patients with extensive tumor burden, but late mortality still occurs from recurrent resistant tumors.