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27 - Gestational trophoblast tumours

Published online by Cambridge University Press:  23 December 2009

Philip Savage
Affiliation:
Consultant, Medical Oncologist, Department of Health, Gestational Trophoblastic Tumour Unit, Charing Cross Hospital, London, UK
Louise Hanna
Affiliation:
Velindre Hospital, Cardiff
Tom Crosby
Affiliation:
Velindre Hospital, Cardiff
Fergus Macbeth
Affiliation:
Velindre Hospital, Cardiff
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Summary

Introduction

Gestational trophoblast tumours (GTTs) are a group of rare but highly curable diseases. The diagnoses form a spectrum from the rarely malignant partial molar pregnancy through to the aggressive malignancies of choriocarcinoma and placental site trophoblast tumour. Fortunately, with effective treatment, nearly all patients can be cured, even those presenting with advanced metastatic disease.

To provide an optimal service for this rare malignancy, the Department of Health in the UK directly funds a national human chorionic gonadotrophin (HCG) surveillance programme for all molar pregnancy patients as well as a follow-up service for treated GTT patients. The medical treatment of GTT in the UK is also centralised; there are two centres, one at Weston Park Hospital in Sheffield and the other at Charing Cross Hospital in London.

Although the main clinical care for GTTs is centralised, it remains important for all UK oncologists to have a working knowledge of GTT because choriocarcinoma and placental site trophoblast tumour (PSTT) can occur as malignancies of unknown primary with a wide range of presentations. In these patients, early involvement from the local oncology team in achieving the correct diagnosis can be lifesaving.

The pattern of GTT management in other countries varies; some countries have established centralised care, whereas, in many other countries, patients are treated locally by doctors who are likely to only see a case every few years.

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Publisher: Cambridge University Press
Print publication year: 2008

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References

Bagshawe, K. D., Dent, J., Newlands, E. S.et al. (1989). The role of low-dose methotrexate and folinic acid in gestational trophoblastic tumours (gestational trophoblast tumour). Br. J. Obstet. Gynaecol., 96, 795–802.CrossRefGoogle Scholar
Bower, M., Newlands, E. S., Holden, L.et al. (1997). epithelial membrane antigen/CO for high-risk gestational trophoblastic tumors: results from a cohort of 272 patients. J. Clin. Oncol., 15, 2636–43.CrossRefGoogle Scholar
Bower, M., Rustin, G. J., Newlands, E. S.et al. (1998). Chemotherapy for gestational trophoblastic tumours hastens menopause by 3 years. Eur. J. Cancer, 34, 1204–7.CrossRefGoogle ScholarPubMed
Cole, L. A., Shahabi, S., Butler, S. A.et al. (2001). Utility of commonly used commercial human chorionic gonadotropin immunoassays in the diagnosis and management of trophoblastic diseases. Clin. Chem., 47, 308–15.Google ScholarPubMed
Federation Internationale de Gynecologie et d'Obstetrique Oncology Committee (2002). Federation Internationale de Gynecologie et d'Obstetrique staging for gestational trophoblastic neoplasia 2000. Int. J. Gynaecol. Obstet., 77, 285–7.CrossRef
Goldstein, D. P., Garner, E. I., Feltmate, C. M.et al. (2004). Comment on ‘The role of repeat uterine evacuation in the management of persistent gestational trophoblastic disease.’Gynecol. Oncol., 95, 421–2.CrossRefGoogle Scholar
Kim, S. J., Lee, C., Kwon, S. Y.et al. (2004). Studying changes in the incidence, diagnosis and management of GTD: the South Korean model. J. Reprod. Med., 49, 643–54.Google ScholarPubMed
McNeish, I. A., Strickland, S., Holden, L.et al. (2002). Low-risk persistent gestational trophoblastic disease: outcome after initial treatment with low-dose methotrexate and folinic acid from 1992 to 2000. J. Clin. Oncol., 20, 1838–44.CrossRefGoogle ScholarPubMed
Newlands, E. S., Bagshawe, K. D., Begent, R. H.et al. (1991). Results with the epithelial membrane antigen/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) regimen in high risk gestational trophoblastic tumours, 1979 to 1989. Br. J. Obstet. Gynaecol., 98, 550–7.CrossRefGoogle Scholar
Newlands, E. S., Mulholland, P. J., Holden, L.et al. (2000). Etoposide and cisplatin/etoposide, methotrexate, and actinomycin D (epithelial membrane antigen) chemotherapy for patients with high-risk gestational trophoblastic tumors refractory to epithelial membrane antigen/cyclophosphamide and vincristine chemotherapy and patients presenting with metastatic placental site trophoblastic tumors. J. Clin. Oncol., 18, 854–9.CrossRefGoogle Scholar
Newlands, E. S., Holden, L., Seckl, M. J.et al. (2002). Management of brain metastases in patients with high-risk gestational trophoblastic tumors. J. Reprod. Med., 47, 465–71.Google ScholarPubMed
Papadopoulos, A. J., Foskett, M., Seckl, M. J.et al. (2002). Twenty-five years' clinical experience with placental site trophoblastic tumors. J. Reprod. Med., 47, 460–4.Google ScholarPubMed
Paradinas, F. J. (1998). The diagnosis and prognosis of molar pregnancy: the experience of the National Referral Centre in London. Int. J. Gynaecol. Obstet., 60 (Suppl. 1), S57–64.CrossRefGoogle Scholar
Pezeshki, M., Hancock, B. W., Silcocks, P.et al. (2004). The role of repeat uterine evacuation in the management of persistent gestational trophoblastic disease. Gynecol. Oncol., 95, 423–9.CrossRefGoogle ScholarPubMed
Powles, T., Young, A., Short, D.et al. (2006). The outcome of patients with relapsed gestational trophoblastic neoplasm (GTN) after the completion of chemotherapy. J. Clin. Oncol., 24 (Suppl.), 5033.Google Scholar
Rustin, G. J., Newlands, E. S., Lutz, J. M.et al. (1996). Combination but not single-agent methotrexate chemotherapy for gestational trophoblastic tumors increases the incidence of second tumors. J. Clin. Oncol., 14, 2769–73.CrossRefGoogle Scholar
Savage, P. and Seckl, M. J. (2005). The role of repeat uterine evacuation in trophoblast disease. Gynecol. Oncol., 99, 251–2.CrossRefGoogle ScholarPubMed
Sebire, N. J., Foskett, M., Fisher, R. A.et al. (2002). Risk of partial and complete hydatidiform molar pregnancy in relation to maternal age. Br. J. Obstet. Gynecol., 109, 99–102.CrossRefGoogle ScholarPubMed
Sebire, N. J., Fisher, R. A., Foskett, M.et al. (2003). Risk of recurrent hydatidiform mole and subsequent pregnancy outcome following complete or partial hydatidiform molar pregnancy. Br. J. Obstet. Gynecol., 110, 22–6.CrossRefGoogle ScholarPubMed
Smith, H. O. and Kim, S. J. (2003). In Gestational Trophoblastic Diseases, ed. Hancock, B. W., Newlands, E. S., Berkowitz, R. S.et al., 2nd edn. Sheffield: International Society for the Study of Trophoblastic Diseases.Google Scholar
Hancock, B. W., Newlands, E. S., Berkowitz, R. S.et al. (2003). Gestational Trophoblastic Disease, 2nd edn. Sheffield: International Society for the Study of Trophoblastic Diseases.Google ScholarPubMed
International Society for the Study of Trophoblastic Diseases (ISSTD). http://www.isstd.org/index.html (accessed September 2006).
Royal College of Obstetricians and Gynaecologists (RCOG). (2004). The Management of Gestational Trophoblastic Neoplasia. RCOG Guideline No. 38. London: Royal College of Obstetricians and Gynaecologists.
Soper, J. T., Mutch, D. G. and Schink, J. C. (2004). Diagnosis and treatment of gestational trophoblastic disease: ACOG Practice Bulletin no. 53. Gynecol. Oncol., 93, 575–85.Google ScholarPubMed

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