Formalised consensus of the European Organisation for Treatment of Trophoblastic Diseases on management of gestational trophoblastic diseases

Bolze, Pierre‐Adrien; Attia, Jocelyne; Massardier, Jérôme; Seckl, Michael J.; Massuger, Leon F.A.G.; Trommel, Nienke E. van; Niemann, Isa; Hajri, Touria; Schott, Anne-Marie; Golfier, François

doi:10.1016/j.ejca.2015.05.026

Cited by 59 publications

(45 citation statements)

References 11 publications

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“…An important study that contributes to this structure is the formalized consensus of Bolze et al4 The author asked 45 experts from 16 countries of the EOTTD to rate 56 statements about the management of gestational trophoblastic disease 4. They used a two-round ‘modified Delphi’ process.…”

Section: Discussionmentioning

confidence: 99%

“…However, for trophoblastic diseases a European network of experts was previously established in 2010 called the European Organization for Treatment of Trophoblastic Diseases (EOTTD). This organization is dedicated to optimizing the diagnosis, treatment, follow-up and research of gestational trophoblastic disease, bringing together the knowledge of clinicians and researchers from many countries across this continent 4. The EOTTD meets once a year and has established several working parties including laboratory, pathology, database and clinical management.…”

Section: Introductionmentioning

confidence: 99%

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Is there uniformity in definitions and treatment of gestational trophoblastic disease in Europe?

Frijstein

Lok

Coulter

et al. 2019

Int J Gynecol Cancer

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ObjectivesBecause gestational trophoblastic disease is rare, little evidence is available from randomized controlled trials on optimal treatment and follow-up. Treatment protocols vary within Europe, and even between different centers within countries. One of the goals of the European Organization for Treatment of Trophoblastic Diseases (EOTTD) is to harmonize treatment in Europe. To provide a basis for international standardization of definitions, treatment and follow-up protocols in gestational trophoblastic disease, we evaluated differences and similarities between protocols in EOTTD countries.MethodsMembers from each EOTTD country were asked to complete an online structured questionnaire comprising multiple-choice and multiple-answer questions. The following themes were discussed: incidence of gestational trophoblastic disease and gestational trophoblastic neoplasia, definitions, guidelines, classification system, treatment, recurrence, and follow-up.ResultsForty-four respondents from 17 countries participated in this study. Guidelines were present in 80% of the countries and the FIGO (Fédération Internationale de Gynécologie et d'Obstétrique) staging and risk classification was often used to estimate risks. Agreement about when to start chemotherapy for post-molar gestational trophoblastic neoplasia was present among 66% of the respondents. Preferred first-line treatments in low- and high-risk gestational trophoblastic neoplasia were methotrexate (81%) and EMA-CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) (93%), respectively. The definition of human chorionic gonadotropin normalization after hydatidiform mole evacuation was two consecutive normal values for nine countries. The FIGO definition of post-molar gestational trophoblastic neoplasia based on human chorionic gonadotropin plateau or rise was agreed on by 69% of respondents, and only 69% and 74% defined low-risk and high-risk disease, respectively, using FIGO criteria. There were major differences in definitions of recurrence, chemotherapy resistance and follow-up protocols among countries, despite EOTTD consensus statements.ConclusionsThis questionnaire provides a good overview of current clinical practices in different countries. Based on the survey results, it is clear that there are several gestationaltrophoblastic disease-related topics that need urgent attention within the EOTTD community to create more uniformity and to aid the development of uniform guidelines in Europe.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Is there uniformity in definitions and treatment of gestational trophoblastic disease in Europe?

Frijstein

Lok

Coulter

et al. 2019

Int J Gynecol Cancer

View full text Add to dashboard Cite

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“…Single-agent chemotherapy with Injectable Methotrexate is used in non-metastatic and low-risk choriocarcinomas (score ≤6). Multi-agent chemotherapy and radiotherapy are used for high-risk, metastatic choriocarcinomas (score >6) [6,7]. In our case multi drug regimen (EMACO) was started in view of high risk disease.…”

Section: Discussionmentioning

confidence: 94%

Choriocarcinoma with Uterine Rupture and Shock: A Rare Case Report

Kumar

Pyrbot

et al. 2015

JCDR

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A 28-year-old P2 was admitted with complaints of amenorrhea for 4 months with irregular bleeding per vaginum. She had complaints of difficulty in breathing and abdominal distension since 4 days. Urine for pregnancy test was positive. She had Hb of 3.5gm%. White blood count, platelets, coagulation profile, liver function tests and renal function tests were normal. Ultrasound showed grossly enlarged mass with miscellaneous echogenic shadows in the myometrium with loss of endometrial junction, multi cystic ovaries with massive ascites and a diagnosis of Gestational Trophoblastic Disease (GTD) was made. Her last child birth was 2 years back and she did not have any history of abortion or molar pregnancy in the past. The patient had features of hypovolemic shock with anaemia. She had received three units of blood transfusion and was on ionotropic support. Then the patient was referred to our institute for further management.

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“…Early tumor resection is believed to be an effective method (9). However, the best time for surgery is always missed when carcinoma is identified due to the high degree of malignancy and early bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…2 and 3). The laboratory results were as follows: White blood cell count, 16.59x10 9 /l (normal, 4-10x10 9 /l); hemoglobin, 131 g/l (normal, 120-160 g/l); platelets, 277x10 9 /l (normal, 100-300x10 9 /l); C-reactive protein, 132 mg/l (normal, 0-8 mg/l); alanine aminotransferase, 93 U/l (normal, 0-40 U/l); total bilirubin, 25.6 µmol/l (normal, 3.42-17.1 µmol/l); direct bilirubin, 16.62 µmol/l (nor ma l, 0 -6. 84 µmol / l) a nd a lbum i n, 25.7 g / l (normal, 35-55 g/l The presence of ACE within the normal range ruled out sarcoidosis.…”

Section: Case Reportmentioning

confidence: 99%

Choriocarcinoma of unknown origin with multiple organ metastasis and cerebral hemorrhage: A case report and literature review

et al. 2016

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Formalised consensus of the European Organisation for Treatment of Trophoblastic Diseases on management of gestational trophoblastic diseases

Cited by 59 publications

References 11 publications

Is there uniformity in definitions and treatment of gestational trophoblastic disease in Europe?

Is there uniformity in definitions and treatment of gestational trophoblastic disease in Europe?

Choriocarcinoma with Uterine Rupture and Shock: A Rare Case Report

Choriocarcinoma of unknown origin with multiple organ metastasis and cerebral hemorrhage: A case report and literature review

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