Gestational Trophoblastic Disease ECHO-Gestational Trophoblastic Disease ECHO

Video Transcription

Video Summary

The inaugural Gestational Trophoblastic Disease (GTD) Echo, organized by ISSTD, ISGYP, and IGCS, focused on low-risk gestational trophoblastic neoplasia (GTN). Dr. Kevin Elias presented a case of a 20-year-old woman with a complete molar pregnancy complicated by post-molar GTN, highlighting diagnosis, staging, and management. Key diagnostic criteria include serial HCG measurements showing a rise or plateau. Imaging with chest X-ray and pelvic ultrasound is standard, with CT scans reserved for suspicious metastases. Vaginal lesions indicated stage II disease with a low-risk prognostic score, allowing single-agent chemotherapy as initial treatment.<br /><br />Single-agent chemotherapy options include methotrexate and dactinomycin; choice depends on factors like toxicity, patient convenience, and availability. In this case, dactinomycin was preferred due to patient transportation issues. Treatment response was monitored by HCG trends; resistance warranted switching agents. Consolidation chemotherapy cycles post-HCG normalization are debated, commonly two to three cycles are recommended.<br /><br />Discussion emphasized the importance of multidisciplinary care, individualized treatment decisions, fertility considerations, and global disparities in care access. Hysterectomy may be considered for selected patients, particularly older women or those with localized disease, to reduce chemotherapy need.<br /><br />The session underscored excellent cure rates for low-risk GTN with proper management and encouraged international collaboration and consultation with GTD experts for optimal patient outcomes.

Keywords

Gestational Trophoblastic Disease

Low-risk GTN

Complete molar pregnancy

Post-molar GTN

HCG monitoring

Single-agent chemotherapy

Methotrexate

Dactinomycin

Multidisciplinary care