Diagnosis and management of gestational trophoblastic disease: 2021 update. (20th October 2021)

• Record Type: Journal Article
• Authors: Ngan, Hextan Y. S.; Seckl, Michael J.; Berkowitz, Ross S.; Xiang, Yang; Golfier, François; Sekharan, Paradan K.; Lurain, John R.; Massuger, Leon
• Other Names: Kehoe Sean guestEditor.; Bhatla Neerja guestEditor.
• Is Part Of: International journal of gynaecology and obstetrics. Volume 155(2021)Supplement 1
• Page Start: 86
• Page End: 93
• Publication Date: 2021-10-20
• Subjects: choriocarcinoma -- epithelioid trophoblastic tumor -- FIGO Cancer Report -- gestational trophoblastic disease -- gestational trophoblastic neoplasia -- moles -- placental site trophoblastic tumor; Gynecology -- Periodicals; Obstetrics -- Periodicals; Electronic journals; 618
• DOI: 10.1002/ijgo.13877
• Languages: English
• ISSNs: 0020-7292

Abstract

Abstract: 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 histological 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 multiagent 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 treatment‐resistant tumors. Synopsis: Gestational trophoblastic disease, although rare, needs special attention because if managed properly, likelihood of cure is almost 100%.