Trophoblastic Disease Review for Diagnosis and Management: A Joint Report From the International Society for the Study of Trophoblastic Disease, European Organisation for the Treatment of Trophoblastic Disease, and the Gynecologic Cancer InterGroup

Mangili, Giorgia; Lorusso, Domenica; Brown, Jubilee; Pfisterer, Jacobus; Massuger, Leon F.A.G.; Vaughan, Michelle; Ngan, Hextan Y.S.; Golfier, François; Sekharan, Paradan K.; Charry, R; Poveda, Andrés; Kim, Jae Weon; Xiang, Yang; Berkowtiz, Ross S.; Seckl, Michael J.

doi:10.1097/igc.0000000000000294

Cited by 115 publications

(117 citation statements)

References 28 publications

Supporting

Mentioning

112

Contrasting

Unclassified

Order By: Relevance

“…Given that many women who develop gestational trophoblastic neoplasia are of childbearing age, preservation of fertility becomes an important consideration 1. Chemotherapy is the treatment of choice for gestational trophoblastic neoplasia and the option between single- and multiple-agent chemotherapy is based on the International Federation of Gynecology and Obstetrics (FIGO) prognostic score 2. Women scoring <7 are classified as low-risk and are generally treated with single-agent chemotherapy, usually methotrexate or actinomycin-D, with an overall cure rate of nearly 100% 2.…”

Section: Introductionmentioning

confidence: 99%

Gestational trophoblastic neoplasia: a meta-analysis evaluating reproductive and obstetrical outcomes after administration of chemotherapy

Tranoulis

Georgiou

Sayasneh

et al. 2019

Int J Gynecol Cancer

View full text Add to dashboard Cite

IntroductionGestational trophoblastic neoplasia represents a rare placental malignancy spectrum that is treated with single- or multi-agent chemotherapy. This disease often impacts women of childbearing age, making post-chemotherapy fertility and obstetrical outcomes an important consideration. We aimed to ascertain the pregnancy rates and obstetric outcomes in women with gestational trophoblastic neoplasia after undergoing treatment with chemotherapy.MethodsA systematic literature review was conducted to identify studies that reported post-chemotherapy fertility and obstetric outcomes among women with gestational trophoblastic neoplasia. We performed a single-proportion meta-analysis for the outcomes of conception/pregnancy rate, term live birth rate, first and second trimester spontaneous abortions rate, stillbirth rate, premature delivery rate, and fetal/neonatal malformation rate.ResultsA total of 27 studies were included in the analysis. The median age ranged between 25.5 and 33.1 years. The pregnancy rate among women with a desire to conceive, comprising a total of 1329 women and 1192 pregnancies, was 86.7% (95% CI 80.8% to 91.6%). The term live birth rate in 6752 pregnancies was 75.84% (95% CI 73.4% to 78.2%). The adverse pregnancy outcomes were seemingly comparable to those of the general population apart from a minor increase in the stillbirth rate. The pooled proportion for the outcome of malformation rate was 1.76% (95% CI 1.3% to 2.2%). The repeat mole rate in 6384 pregnancies was 1.28% (95% CI 0.95% to 1.66%). Subsequent sub-group analysis indicated that neither multi-agent chemotherapy nor conception within 12 months post-chemotherapy increased the adverse obstetric events risk or fetal malformations.ConclusionsNearly 90% of patients desiring future fertility after chemotherapy for gestational trophoblastic disease were able to conceive. In addition, adverse pregnancy outcomes were similar to that in the general population. Multi-agent chemotherapy does not seemingly increase the malformation rate.

show abstract

Section: Introductionmentioning

confidence: 99%

Gestational trophoblastic neoplasia: a meta-analysis evaluating reproductive and obstetrical outcomes after administration of chemotherapy

Tranoulis

Georgiou

Sayasneh

et al. 2019

Int J Gynecol Cancer

View full text Add to dashboard Cite

show abstract

“…A risk-adapted chemotherapy based on FIGO staging and World Health Organization scoring has been established for GTNs: patients in the low-risk metastatic group are treated with single-agent chemotherapy, those in the high-risk group with multipleagent chemotherapy (15). Cure rates approach 100% for low-risk patients and 80% to 90% for high-risk patients (16).…”

Section: Discussionmentioning

confidence: 99%

Clinicopathologic Analysis of Postchemotherapy Gestational Trophoblastic Neoplasia: An Entity Overlapping With Epithelioid Trophoblastic Tumor

Lü

Zhang

Liang

2016

International Journal of Gynecological Pathology

View full text Add to dashboard Cite

Surgery is generally not required for the majority of gestational trophoblastic neoplasias (GTNs) because they are potentially curable by chemotherapy alone. The histologic assessment is rarely available although the identification of a specific subtype of GTN is relevant to clinical intervention and prognostic prediction. In this study, we analyzed the clinicopathologic features of 4 postchemotherapy GTNs. They presented as a persistent uterine (Cases 1, 2, and 3) or pelvic mass (Case 4) with a raised serum β-hCG level after multiple courses of chemotherapy. All patients were alive without evidence of disease at follow-up periods of 58 to 109 mo after surgery and salvage chemotherapy except for Case 4 which had a recurrent pelvic mass. These GTNs had a characteristic histopathologic pattern of extensive necrosis and a rim of scant viable mononucleated tumor cells at the periphery of the lesion. Immunostaining showed that these tumor cells had a lower Ki67 index than choriocarcinoma, and epithelioid trophoblastic cell tumor although they exhibited an epithelioid trophoblastic cell tumor-like immunostaining pattern (CD146, hPL, and p63). A small number of β-hCG-positive multinucleated trophoblastic cells were also present in 3 of the 4 cases. We suggest that these postchemotherapy GTNs may represent a "snap shot" of the hypothetical choriocarcinoma-epithelioid trophoblastic cell tumor transition. Our findings should provide insights into the pathogenesis of GTNs.

show abstract

“…In Italy specifically, the estimated frequency of HM is 1 case every 935 pregnancies [2]. In Europe and North America, CCA affects approximately 1 in 40,000 pregnancies, while for PSTT the incidence is estimated at 0.2% of all GTD; ETT is a relatively new entity and data regarding its epidemiology are scarce [1].…”

Section: Introductionmentioning

confidence: 99%

“…After chemotherapy, the β-hCG follow-up goes on for at least 1 year. In the case of chemotherapy-insensitive PSTT, hysterectomy may be the only course of action [1]. During follow-up, contraception is recommended: this is to distinguish a rising β-hCG due to persistent or re-current disease from a rising β-hCG associated with a subsequent pregnancy [4].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Illness Perception in Gestational Trophoblastic Disease Patients: How Mental Representations Affect Anxiety, Depression, and Infertility-Related Stress

Carnelli¹,

Mattei²,

Mazzetti³

et al. 2017

OJMP

Self Cite

View full text Add to dashboard Cite

Gestational Trophoblastic Disease encompasses a group of pregnancy-related disorders that derive from the placenta. Taking Leventhal's Common Sense Model as a starting point, this study aims to investigate how illness perception could influence patients' psychological adaptation to these rare diseases. Thirty-seven women completed: the Illness Perception Questionnaire-Revised, the Beck Depression Inventory Short Form, the State-Trait Anxiety Inventory, and the Fertility Problem Inventory. Results show that the perception of severe illness consequences significantly predicts the level of anxiety patients reported at the time of questionnaire completion. Furthermore, mental representations of illness present a significant association with infertility-related stress. Specifically, the belief in the efficacy of the treatment results in fewer feelings of discomfort and isolation from family and social context due to infertility-related problems. Since patients' illness perception was found to have a specific impact on both anxiety and infertility-related stress, this variable should be considered in the planning of a clinical intervention.

show abstract

Trophoblastic Disease Review for Diagnosis and Management: A Joint Report From the International Society for the Study of Trophoblastic Disease, European Organisation for the Treatment of Trophoblastic Disease, and the Gynecologic Cancer InterGroup

Abstract: Guidelines were constructed on the basis of literature review. After initial diagnosis in local centers, centralization of pathology review and ongoing care is recommended to achieve the best outcomes.

Cited by 115 publications

References 28 publications

Gestational trophoblastic neoplasia: a meta-analysis evaluating reproductive and obstetrical outcomes after administration of chemotherapy

Gestational trophoblastic neoplasia: a meta-analysis evaluating reproductive and obstetrical outcomes after administration of chemotherapy

Clinicopathologic Analysis of Postchemotherapy Gestational Trophoblastic Neoplasia: An Entity Overlapping With Epithelioid Trophoblastic Tumor

Illness Perception in Gestational Trophoblastic Disease Patients: How Mental Representations Affect Anxiety, Depression, and Infertility-Related Stress

Contact Info

Product

Resources

About