Challenges in the Diagnosis and Treatment of Gestational Trophoblastic Neoplasia Worldwide

Overview

Journal World J Clin Oncol

Publisher Baishideng Publishing Group

Specialty Oncology

Date 2019 Mar 1

PMID 30815369

Citations 27

Authors

Antonio Braga

Paulo Mora

Andreia Cristina de Melo

Angelica Nogueira-Rodrigues

Joffre Amim-Junior

Jorge Rezende-Filho

Michael J Seckl

Affiliations

Soon will be listed here.

Abstract

Gestational trophoblastic neoplasia (GTN) is a rare tumor that originates from pregnancy that includes invasive mole, choriocarcinoma (CCA), placental site trophoblastic tumor and epithelioid trophoblastic tumor (PSTT/ETT). GTN presents different degrees of proliferation, invasion and dissemination, but, if treated in reference centers, has high cure rates, even in multi-metastatic cases. The diagnosis of GTN following a hydatidiform molar pregnancy is made according to the International Federation of Gynecology and Obstetrics (FIGO) 2000 criteria: four or more plateaued human chorionic gonadotropin (hCG) concentrations over three weeks; rise in hCG for three consecutive weekly measurements over at least a period of 2 weeks or more; and an elevated but falling hCG concentrations six or more months after molar evacuation. However, the latter reason for treatment is no longer used by many centers. In addition, GTN is diagnosed with a pathological diagnosis of CCA or PSTT/ETT. For staging after a molar pregnancy, FIGO recommends pelvic-transvaginal Doppler ultrasound and chest X-ray. In cases of pulmonary metastases with more than 1 cm, the screening should be complemented with chest computed tomography and brain magnetic resonance image. Single agent chemotherapy, usually Methotrexate (MTX) or Actinomycin-D (Act-D), can cure about 70% of patients with FIGO/World Health Organization (WHO) prognosis risk score ≤ 6 (low risk), reserving multiple agent chemotherapy, such as EMA/CO (Etoposide, MTX, Act-D, Cyclophosphamide and Oncovin) for cases with FIGO/WHO prognosis risk score ≥ 7 (high risk) that is often metastatic. Best overall cure rates for low and high risk disease is close to 100% and > 95%, respectively. The management of PSTT/ETT differs and cure rates tend to be a bit lower. The early diagnosis of this disease and the appropriate treatment avoid maternal death, allow the healing and maintenance of the reproductive potential of these women.

Citing Articles

Gestational Trophoblastic Disease: Complete versus Partial Hydatidiform Moles.

Gonzalez J, Popp M, Ocejo S, Abreu A, Bahmad H, Poppiti R Diseases. 2024; 12(7).

PMID: 39057130 PMC: 11276430. DOI: 10.3390/diseases12070159.

Review of current literature on gestational trophoblastic neoplasia.

Shahzadi M, Khan S, Tariq M, Baloch S, Shahid A, Moosajee M J Egypt Natl Canc Inst. 2023; 35(1):37.

PMID: 38008872 DOI: 10.1186/s43046-023-00195-y.

Clinical features and demographic characteristics of gestational trophoblastic neoplasia: Single center experience and the SEER database.

Hou Y, Li P, Yu H, Feng F, He X, Chen B Biomol Biomed. 2023; 24(1):176-187.

PMID: 37485958 PMC: 10787625. DOI: 10.17305/bb.2023.9092.

Advances in the diagnosis and early management of gestational trophoblastic disease.

Joyce C, Fitzgerald B, McCarthy T, Coulter J, ODonoghue K BMJ Med. 2023; 1(1):e000321.

PMID: 36936581 PMC: 9978730. DOI: 10.1136/bmjmed-2022-000321.

Dysgerminoma Masquerading as Gestational Trophoblastic Neoplasia.

Blackwell C, McLeish S, Iglesias D, Armbruster S Case Rep Obstet Gynecol. 2023; 2023:1901858.

PMID: 36817070 PMC: 9931483. DOI: 10.1155/2023/1901858.

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