Prophylactic chemotherapy for hydatidiform mole to prevent gestational trophoblastic neoplasia

Wang, Qiuyi; Fu, Jing; Hu, Lina; Fang, Fang; Xie, Lizhi; Chen, Hengxi; He, Fan; Wu, Taixiang; Lawrie, Theresa A

doi:10.1002/14651858.cd007289.pub3

Cited by 45 publications

(52 citation statements)

References 38 publications

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“…A Cochrane database review (3 randomized controlled trials [RCTs], n5613) did not conclude sufficient evidence for standard administration of prophylactic chemotherapy to prevent postmolar GTN; however, evidence was suggestive that prophylactic chemotherapy may reduce the risk of progression to GTN among women with complete HM at high risk for malignant transformation. 15 The NCCN Guidelines state that prophylactic methotrexate or dactinomycin can be considered for patients deemed at high risk for postmolar GTN. Risk factors for postmolar GTN include age .40 years, hCG levels in excess of 100,000 mIU/mL, excessive uterine enlargement, and/or theca lutein cysts larger than 6 cm.…”

Section: Treatmentmentioning

confidence: 99%

“…Risk factors for postmolar GTN include age .40 years, hCG levels in excess of 100,000 mIU/mL, excessive uterine enlargement, and/or theca lutein cysts larger than 6 cm. 2,8,15,16 Follow-up Follow-up with hCG monitoring is essential after initial treatment of HM to ensure that hCG levels return to normal. The hCG molecules associated with GTD are more heterogenous and degraded than those associated with normal pregnancy.…”

Section: Treatmentmentioning

confidence: 99%

See 1 more Smart Citation

Gestational Trophoblastic Neoplasia, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology

Abu‐Rustum

Yashar

Bean

et al. 2019

Journal of the National Comprehensive Cancer Network

105

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Gestational trophoblastic neoplasia (GTN), a subset of gestational trophoblastic disease (GTD), occurs when tumors develop in the cells that would normally form the placenta during pregnancy. The NCCN Guidelines for Gestational Trophoblastic Neoplasia provides treatment recommendations for various types of GTD including hydatidiform mole, persistent post-molar GTN, low-risk GTN, high-risk GTN, and intermediate trophoblastic tumor.

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Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Gestational Trophoblastic Neoplasia, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology

Abu‐Rustum

Yashar

Bean

et al. 2019

Journal of the National Comprehensive Cancer Network

105

View full text Add to dashboard Cite

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“…The analysis of almost 90 papers allowed to conclude that a prophylactic chemotherapy may decrease the risk of progression to GTN in women with complete mole pregnancy, in whose case there is a high risk of malignant transformation, yet the current evidence for the benefits of this therapy is quite limited by their low quality and a small number of patients in the analysed trials. Preventive chemotherapy may increase drug resistance, delay healing and cause side effects and that is why it cannot be routinely recommended and used [23]. Braga et al evaluated expectant versus immediate chemotherapy following pathological diagnosis of gestational choriocarcinoma in patients with nonmetastatic disease and concluded that close surveillance of women with pathological diagnosis of nonmetastatic gestational choriocarcinoma seems to be a safe practice [24].…”

Section: Discussion and Review Of The Literaturementioning

confidence: 99%

Current treatment options for advanced choriocarcinoma on the basis of own case and review of the literature

Wreczycka-Cegielny

Cegielny

Opławski³

et al. 2018

Ginekol Pol

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Choriocarcinoma is one of rare neoplasms of female reproductive organs. In the last decade only a few cases of this disease have been registered in Poland. The paper presents the current principles of diagnosis and treatment options for this rare disease based on the authors' clinical experience (description of the case) and literature review. This paper provides basic information on epidemiology, FIGO classification, and also discusses the chemotherapy regimens used in the medical treatment of choriocarcinoma. Surgical options were also considered. A thematic review of the most important papers published in international journals in recent years has also been made.

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“…To reduce this malignant sequel, prophylactic single-agent chemotherapy after molar evacuation has been recommended for "highrisk" moles in patients having maternal age above 40 years [5]. However, Jiang et al and Geng et al have reported no significant decrease in postmolar GTN after prophylactic chemotherapy [6,7].…”

Section: Introductionmentioning

confidence: 99%

Prognosis of Gestational Trophoblastic Neoplasia in Women at 40 Years Old and Above: A Multicentre Retrospective Study

Hemida¹,

Sauthier²,

Toson³

et al. 2020

COR

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Purpose: To investigate the outcome of different treatment strategies in patients with gestational trophoblastic neoplasia (GTN) in women at 40 years old and above. Patients and Methods: We analysed a historical cohort from 5 referral centres from 5 countries, including all women with GTN treated between 2012 and 2017, who were 40 years old and older. Baseline characteristics and outcome of different treatment strategies were recorded and evaluated. The patients were categorized into low-risk non-metastatic, low-risk metastatic and high-risk, based on the FIGO classification. Results: A total of 141 cases were identified, of which 112 cases fulfilled the inclusion criteria. Mean age was 45.4 years ± 4.2SD. Of 80 patients with LR non-metastatic GTN, 46 women received single agent chemotherapy and 34 a hysterectomy with or without (n = 4) chemotherapy. Higher remission rate and shorter treatment duration (P=0.001) was seen in the group that underwent hysterectomy. Seven of the 14 patients with low-risk, metastatic GTN were cured with methotrexate. Two of the 18 high risk patients died before treatment, four were treated with polychemotherapy; two of them needed second line chemotherapy for incomplete response. Two cases received induction with methotrexate followed by EMA/CO. Ten highrisk patients were treated with hysterectomy and chemotherapy, of these six achieved complete remission, three needed second line chemotherapy, and one patient died during chemotherapy treatment. Conclusion: In this cohort of women with GTN at 40 years old or above, we found high proportions of metastatic and high-risk cases, of methotrexate resistance, and of need for multiple treatment lines. In all groups, hysterectomy was performed, but its role remains controversial in metastatic low-risk and high-risk disease.

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Prophylactic chemotherapy for hydatidiform mole to prevent gestational trophoblastic neoplasia

Cited by 45 publications

References 38 publications

Gestational Trophoblastic Neoplasia, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology

Gestational Trophoblastic Neoplasia, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology

Current treatment options for advanced choriocarcinoma on the basis of own case and review of the literature

Prognosis of Gestational Trophoblastic Neoplasia in Women at 40 Years Old and Above: A Multicentre Retrospective Study

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