Didactics-Epidemiology, diagnosis, and treatment of gestational trophoblastic disease: A Society of Gynecologic Oncology evidenced-based review and recommendation

Epidemiology, diagnosis, and treatment of gestational trophoblastic disease: A Society of Gynecologic Oncology evidenced-based review and recommendation

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The document provides a comprehensive overview of gestational trophoblastic disease (GTD), including its epidemiology, diagnosis, management, and treatment recommendations as outlined by the Society of Gynecologic Oncology. GTD encompasses a range of tumors arising from abnormal fertilization, which can be benign, potentially malignant, or malignant. Molar pregnancies, invasive moles, choriocarcinoma, and other related conditions fall under the category of gestational trophoblastic neoplasia (GTN).<br /><br />Epidemiologically, GTD occurs more frequently in certain regions, with risk factors including extremes of reproductive age and prior molar pregnancies. Choriocarcinoma, more aggressive than other types, is the most common after a normal pregnancy. Different subtypes like complete (CM) and partial hydatidiform moles (PM) are characterized by genetic differences and differing risks associated with patient age and previous molar pregnancies.<br /><br />Diagnosis largely relies on measurements of human chorionic gonadotropin (hCG), a marker instrumental in detecting GTD, monitoring treatment response, and identifying recurrences. Treatment primarily involves uterine evacuation via suction curettage, with close post-evacuation monitoring through hCG assays to detect potential conversion to GTN.<br /><br />GTN treatment varies by risk, with low-risk cases managed with single-agent chemotherapy like methotrexate or dactinomycin, and high-risk cases requiring multi-agent chemotherapy regimens such as EMA-CO. Ultrahigh-risk GTN, usually indicated by very high WHO risk scores or severe symptoms, may necessitate induction chemotherapy before more aggressive treatment.<br /><br />For persistent or resistant cases, surgery and alternative chemotherapy regimens are recommended. Hysterectomy may also be considered in certain scenarios, particularly for those no longer desiring fertility. Furthermore, follow-up care is critical, involving regular hCG monitoring to ensure remission or early detection of relapse.<br /><br />The document synthesizes data from various studies and trials to offer recommendations tailored to the disease's unique presentation and varied patient needs, while highlighting the importance of individualized care in achieving favorable outcomes.

Asset Subtitle

N.S. Horowitz a,⁎, R.N. Eskander b, M.R. Adelmanc, W. Burke d

Keywords

gestational trophoblastic disease

epidemiology

diagnosis

treatment recommendations

molar pregnancies

choriocarcinoma

human chorionic gonadotropin

chemotherapy

hysterectomy

individualized care