Table of Contents Purpose of This PDQ Summary General Information Cellular Classification Stage Information
Treatment Option Overview Hydatidiform Mole Placental-Site Gestational Trophoblastic Tumors Nonmetastatic Gestational Trophoblastic Tumors Good-Prognosis Metastatic Gestational Trophoblastic Tumors Poor-Prognosis Metastatic Gestational Trophoblastic Tumors Recurrent Gestational Trophoblastic Tumors Get More Information From NCI Changes to This Summary (12/05/2007) More Information
Purpose of This PDQ Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of gestational trophoblastic tumors. This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board.
Information about the following is included in this summary:
- Prognostic factors.
- Cellular classification.
- Staging.
- Treatment options by cancer stage.
This summary is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Some of the reference citations in the summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations. Based on the strength of the available evidence, treatment options are described as either “standard” or “under clinical evaluation.” These classifications should not be used as a basis for reimbursement determinations.
This summary is available in a patient version, written in less technical language, and in Spanish.
Back to Top General Information
Gestational trophoblastic tumors (GTTs) are rare but highly curable tumors
arising from the products of conception in the uterus. The prognosis for cure
of patients with GTTs is good even when the disease has spread to distant
organs, especially when only the lungs are involved. The probability of cure
depends on the following:
- Histologic type (mole, invasive mole, or choriocarcinoma).
- Extent of spread of the disease.
- Level of the human chorionic gonadotropin
(hCG) titer.
- Duration of disease from the initial pregnancy event to start
of treatment.
- Specific sites of metastases.
- Nature of antecedent
pregnancy.
- Extent of prior treatment.
Selection of treatment depends
on these factors plus the patient’s desire for future pregnancies. The hCG, produced normally during pregnancy, is abnormally
elevated in the blood and urine of patients with this group of diseases and is
a sensitive marker to indicate the presence or absence of disease before,
during, and after treatment.
The most common antecedent pregnancy is that of a hydatidiform mole, usually a
genetic disorder of pregnancy in which only placental-like tissue is present.
The patient will present with abnormal bleeding from onset of pregnancy and may
have a uterus which is much larger than expected. Sonography is the preferred
method of diagnosis, and suction dilation and curettage (D & C) is the preferred method of evacuation.
Of utmost importance is careful follow-up with serum beta hCG (BhCG) weekly
until less than 100 mIU/mL and then every 2 weeks. The patient should have a
careful pelvic examination every other week and a chest x-ray every 4to 6 weeks.
Once the titer of serum BhCG has fallen to normal levels, these two
examinations need no longer be done; however, BhCG titers need to be repeated
every 2 weeks for 3 months, then monthly for 3 months, then every 2 months for
6 months, then every 6 months for 3 years. Each patient should be counseled in
the use of a reliable birth control method. Any patient who develops an
increasing level of serum BhCG, a plateau of the BhCG over 3 weeks, or
persistent elevation of BhCG after 16 weeks of follow-up should be considered
as having gestational trophoblastic neoplasia and should undergo the
appropriate work-up and treatment. Similarly, any patient who develops
metastatic disease during follow-up should be staged and undergo treatment.
Choriocarcinoma most commonly follows a molar pregnancy but can follow a
normal pregnancy, ectopic pregnancy, or abortion, and should always be
considered when a patient has continued vaginal bleeding in the postdelivery
period. Other common signs include bizarre neurologic symptoms in a female
within the reproductive age group and asymptomatic lesions on routine chest
x-ray.
Back to Top Cellular Classification
Gestational trophoblastic tumors may be classified as follows:[1]
- Hydatidiform
mole.
- Invasive mole (chorioadenoma destruens).
- Choriocarcinoma.
- Placental-site trophoblastic tumor.
Hydatidiform mole
Hydatidiform mole is defined as products of conception that lack an intact
fetus and show gross cyst-like swellings of the chorionic villi caused by an
accumulation of fluid. There is disintegration and loss of blood vessels in
the villous core.
Invasive mole
Invasive mole (chorioadenoma destruens) is a locally invasive, rarely
metastatic lesion characterized microscopically by trophoblastic invasion of
the myometrium with identifiable villous structures. Microscopically, this
lesion is characterized by hyperplasia of cytotrophoblastic and syncytial
elements and persistence of villous structures.
Choriocarcinoma
Choriocarcinoma is a malignant tumor of the trophoblastic epithelium. Uterine
muscle and blood vessels are invaded with areas of hemorrhage and necrosis.
Columns and sheets of trophoblastic tissue invade normal tissues and spread to
distant sites, the most common of which are lungs, brain, liver, pelvis,
vagina, spleen, intestines, and kidney.
Placental-site trophoblastic tumor
Placental-site trophoblastic disease is an extremely rare tumor arising from
the placental implantation site and resembles an exaggerated form of syncytial
endometritis. Trophoblastic cells infiltrate the myometrium, and there is
vascular invasion. Human placental lactogen is present in the tumor cells,
while immunoperoxidase staining for human chorionic gonadotropin (hCG) is positive in only scattered cells,
and serum hCG is relatively low.[1]
References
-
Lurain JR: Gestational trophoblastic tumors. Semin Surg Oncol 6 (6): 347-53, 1990.
[PUBMED Abstract]
Back to Top Stage Information
Hydatidiform Mole
Hydatidiform mole (molar pregnancy) is disease limited to the uterine cavity.
Invasive mole (chorioadenoma destruens) is a locally invasive, rarely
metastatic lesion.
The FIGO staging system is as follows:[1]
- Stage I: Disease confined to the uterus
- Stage IA: Disease confined to the uterus with no risk factors.
- Stage IB: Disease confined to the uterus with one risk factor.
- Stage IC: Disease confined to the uterus with two risk factors.
- Stage II: Gestational trophoblastic tumor (GTT) extends outside of the uterus but is limited to the genital
structures (ovary, tube, vagina, and broad ligament)
- Stage IIA: GTT involving genital structures without risk factors.
- Stage IIB: GTT extends outside of the uterus but is limited to genital
structures with one risk factor.
- Stage IIC: GTT extends outside of the uterus but is limited to the genital
structures with two risk factors.
- Stage III: GTT extends to the lungs, with or without known genital tract
involvement
- Stage IIIA: GTT extends to the lungs, with or without genital tract
involvement and with no risk factors.
- Stage IIIB: GTT extends to the lungs, with or without genital tract
involvement and with one risk factor.
- Stage IIIC: GTT extends to the lungs, with or without genital tract
involvement and with two risk factors.
- Stage IV: All other metastatic sites
- Stage IVA: All other metastatic sites, without risk factors.
- Stage IVB: All other metastatic sites, with one risk factor.
- Stage IVC: All other metastatic sites, with two risk factors.
The American Joint Committee on Cancer (AJCC) has designated staging by TNM
classification.[1]
TNM Definitions
Primary tumor (T)
- TX: Primary tumor cannot be assessed
- T0: No evidence of primary tumor
- T1: Disease limited to uterus
- T2: Disease outside of uterus but is limited to genital structures (ovary,
tube, vagina, and broad ligaments)
Distant metastasis (M)
- M0: No clinical metastasis
- M1a: Lung metastasis
- M1b: All other distant metastasis
Risk factors affecting staging include the following:
- Human chorionic gonadotropin (hCG) greater than 100,000 IU/24-hour urine.
- The detection of disease more than 6 months from termination of the
antecedent pregnancy.
AJCC Stage Groupings
Stage IA
Stage IB
Stage IC
Stage IIA
Stage IIB
Stage IIC
Stage IIIA
- Any T, M1a, no risk factors
Stage IIIB
- Any T, M1a, one risk factor
Stage IIIC
- Any T, M1a, two risk factors
Stage IVA
- Any T, M1b, no risk factors
Stage IVB
- Any T, M1b, one risk factor
Stage IVC
- Any T, M1b, two risk factors
Most major U.S. Trophoblastic Disease Centers have used a clinical
classification system based on prognostic groups to determine treatment and
report results. In the staging system below, GTT is divided into metastatic
and nonmetastatic, with the former further divided into low-risk and high-risk
based on:[2,3]
- Duration of disease.
- Presence or absence of liver or brain metastasis.
- The hCG titer level.
- Presence or absence of prior chemotherapy.
- Occurrence after a full-term pregnancy.
Nonmetastatic GTTs
Nonmetastatic GTT is defined as no disease outside
the uterus. A diagnosis of nonmetastatic trophoblastic disease is made when
there are persistently elevated hCG titers or a tissue diagnosis of uterine
choriocarcinoma in the absence of detectable metastatic disease. One criterion
used to make the diagnosis relates tumor load to the length of the hCG
plateau.[4]
Good-Prognosis Metastatic GTTs
Indicated by the following factors:
- Last pregnancy less than 4 months ago.
- A low hCG titer (<100,000 IU [24-hour urine] or <40,000 mIU/mL blood).
- No liver or brain metastases.
- No prior chemotherapy.
Poor-Prognosis Metastatic GTTs
Indicated by any of the following factors:
- Last pregnancy more than 4 months ago.
- A high hCG titer (>100,000 IU [24-hour urine] or >40,000 mIU/mL blood).
- Liver or brain metastases.
- Prior chemotherapy.
- Occurrence after a full-term pregnancy.
Metastatic GTTs are also categorized by the WHO scoring system as low-risk,
medium-risk, and high-risk.[5] This scoring system has been suggested for use in
identifying the especially (“ultra”) high-risk patient who is best treated by
the most dose-intensive and efficacious combination chemotherapy protocol. The
WHO scoring system based on prognostic factors is listed below. The individual
scores for each prognostic factor are added together to obtain a total
score.[6] A total score less than or equal to four is considered low risk, a
total score of five to seven is considered middle risk, and a total score of eight or greater
is considered high risk. A study also examined the use of the WHO scoring
system for reporting results of treatment; the results suggested that risk
categories be redefined as low (<8), medium (8–12), and high (>12). Failure of
treatment was limited to patients in the latter group.[7]
Prognostic Factors Based on the WHO Scoring System
Prognostic Factor
|
Score
|
Age
|
<39 |
0 |
>39 |
1 |
Antecedent pregnancy
|
hydatidiform mole |
0 |
abortion |
1 |
term |
2 |
Interval between end of antecedent pregnancy and start of chemotherapy
|
<4 mo |
0 |
4–6 mo |
1 |
7–12 mo |
2 |
>12 mo |
4 |
hCG (IU/mL)
|
<1000 |
0 |
1,000–10,000 |
1 |
10,000–100,000 |
2 |
>100,000 |
4 |
ABO groups (female × male)
|
O × A or A × O |
1 |
B or AB |
2 |
Largest tumor, including uterine
|
3–5 cm |
1 |
>5 cm |
2 |
Site of metastases
|
spleen, kidney |
1 |
gastrointestinal tract or liver |
2 |
brain |
4 |
Number of metastases identified
|
1–4 |
1 |
4–8 |
2 |
>8 |
4 |
Prior chemotherapy
|
single drug |
2 |
2 or more drugs |
4 |
References
-
Gestational trophoblastic tumors. In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual. 5th ed. Philadelphia, Pa: Lippincott-Raven Publishers, 1997, pp 211-214.
-
Lurain JR: Gestational trophoblastic tumors. Semin Surg Oncol 6 (6): 347-53, 1990.
[PUBMED Abstract]
-
Bagshawe KD: Risk and prognostic factors in trophoblastic neoplasia. Cancer 38 (3): 1373-85, 1976.
[PUBMED Abstract]
-
Kohorn EI: Evaluation of the criteria used to make the diagnosis of nonmetastatic gestational trophoblastic neoplasia. Gynecol Oncol 48 (2): 139-47, 1993.
[PUBMED Abstract]
-
World Health Organization Scientific Group.: Gestational trophoblastic diseases. Geneva: World Health Organization, 1983.
-
Tumors of the placental trophoblast. In: Morrow CP, Curtin JP: Synopsis of Gynecologic Oncology. 5th ed. New York, NY: Churchill Livingstone, 1998, pp 315-353.
-
Dubuc-Lissoir J, Sweizig S, Schlaerth JB, et al.: Metastatic gestational trophoblastic disease: a comparison of prognostic classification systems. Gynecol Oncol 45 (1): 40-5, 1992.
[PUBMED Abstract]
Back to Top Treatment Option Overview
Treatment depends on the:
- Cell type.
- Stage.
- Level of serum Beta-human chorionic gonadotrophin (BhCG).
- Duration of
the disease.
- Specific sites of metastasis.
- Extent of prior
treatment.
Of utmost importance in treating patients with gestational trophoblastic tumors is instituting
therapy as quickly as possible and continuing chemotherapy at very close
intervals until normal BhCG titers are obtained. The interval between courses
should rarely exceed 14 to 21 days depending on the treatment. It
is recommended that patients receive one to three courses of chemotherapy
after the first normal BhCG titer, depending on the extent of disease.
Regardless of stage, if one of the high-risk factors is present, the patient
should be treated with combination chemotherapy.
Back to Top Hydatidiform Mole
Hydatidiform mole (molar pregnancy) is 100% curable. The selection of
treatment is based on the desire to preserve reproductive capability.
Standard treatment options:
- Removal of the hydatidiform mole (dilation, suction evacuation, and
curettage).
- Removal of the uterus (hysterectomy). Only in rare situations do the
ovaries require removal.
Following this initial treatment, patients should be monitored with
determination of serum BhCG to document its return to normal. Follow-up with a
urinary pregnancy test is inadequate, and a sensitive radioimmunoassay is
mandatory. Chemotherapy is necessary when there is:
- A rising BhCG titer
for 2 weeks (3 titers).
- A tissue diagnosis of choriocarcinoma.
- A
plateau of the BhCG for 3 weeks.
- Metastatic disease (good prognosis).
- An
elevation in BhCG after a normal value.
- Postevacuation hemorrhage not
caused by retained tissues.
Chemotherapy is required in only 20% of patients after
evacuation of a molar pregnancy. Chemotherapy is the same as for nonmetastatic
gestational trophoblastic tumor.
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with hydatidiform mole. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Back to Top Placental-Site Gestational Trophoblastic Tumors
Hysterectomy is the treatment of choice for patients with placental-site
trophoblastic tumors. Although most reports have noted a benign course for
these tumors, they are relatively resistant to chemotherapy and can be
fatal.[1]
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with placental-site gestational trophoblastic tumor. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
References
-
Lurain JR: Gestational trophoblastic tumors. Semin Surg Oncol 6 (6): 347-53, 1990.
[PUBMED Abstract]
Back to Top Nonmetastatic Gestational Trophoblastic Tumors
This is the most common presentation of gestational trophoblastic tumors and usually requires treatment with
cytotoxic therapy, primarily single agents.
Standard treatment options:
Treatment usually consists of single-agent chemotherapy though hysterectomy
has been used in the occasional patient where preservation of reproductive
function is not an issue. Single-agent chemotherapy is usually methotrexate
unless the patient has abnormal liver function, in which case dactinomycin is
used.
- Methotrexate with leucovorin.[1]
- Dactinomycin.[2]
Other regimens appear to produce similar survival outcomes but have been
studied less extensively or are in less common use. They are:
- Methotrexate.[2-4]
- Etoposide.[5]
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with nonmetastatic gestational trophoblastic tumor. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
References
-
Berkowitz RS, Goldstein DP, Bernstein MR: Ten year's experience with methotrexate and folinic acid as primary therapy for gestational trophoblastic disease. Gynecol Oncol 23 (1): 111-8, 1986.
[PUBMED Abstract]
-
Tumors of the placental trophoblast. In: Morrow CP, Curtin JP: Synopsis of Gynecologic Oncology. 5th ed. New York, NY: Churchill Livingstone, 1998, pp 315-353.
-
Homesley HD, Blessing JA, Rettenmaier M, et al.: Weekly intramuscular methotrexate for nonmetastatic gestational trophoblastic disease. Obstet Gynecol 72 (3 Pt 1): 413-8, 1988.
[PUBMED Abstract]
-
Homesley HD, Blessing JA, Schlaerth J, et al.: Rapid escalation of weekly intramuscular methotrexate for nonmetastatic gestational trophoblastic disease: a Gynecologic Oncology Group study. Gynecol Oncol 39 (3): 305-8, 1990.
[PUBMED Abstract]
-
Wong LC, Choo YC, Ma HK: Primary oral etoposide therapy in gestational trophoblastic disease. An update. Cancer 58 (1): 14-7, 1986.
[PUBMED Abstract]
Back to Top Good-Prognosis Metastatic Gestational Trophoblastic Tumors
This group of patients has disease outside the uterus, but it does not have any of the adverse
prognostic factors detailed in stage information. In general, these patients
should be treated with single-agent chemotherapy as described for nonmetastatic
disease. Patients who do not tolerate methotrexate or who become resistant to
it can often be salvaged with dactinomycin. Development of intercurrent
poor-risk factors dictates the need for combination chemotherapy.
Cure rates should approach 100%, but approximately 40% to 50% of these patients
will develop resistance to the first chemotherapeutic agent and require
alternate treatment. Careful monitoring is mandatory.
Standard treatment options:
- Methotrexate with leucovorin.[1]
- Dactinomycin. Tumors of the placental trophoblast.
- Primary hysterectomy followed by single-agent chemotherapy with methotrexate
or dactinomycin (if patient has completed family).
- Primary chemotherapy followed by secondary hysterectomy for persistent
uterine disease (must verify that metastatic disease has totally regressed).
- For refractory disease:
- MAC: methotrexate plus dactinomycin plus chlorambucil.[2]
Other regimens appear to produce similar survival outcomes but have been
studied less extensively or are in less common use. They are:
- Methotrexate.[2]
- EMA-CO: etoposide plus methotrexate plus dactinomycin and vincristine plus cyclophosphamide.[3]
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with good prognosis metastatic gestational trophoblastic tumor. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
References
-
Berkowitz RS, Goldstein DP, Bernstein MR: Ten year's experience with methotrexate and folinic acid as primary therapy for gestational trophoblastic disease. Gynecol Oncol 23 (1): 111-8, 1986.
[PUBMED Abstract]
-
Tumors of the placental trophoblast. In: Morrow CP, Curtin JP: Synopsis of Gynecologic Oncology. 5th ed. New York, NY: Churchill Livingstone, 1998, pp 315-353.
-
Bagshawe KD: High-risk metastatic trophoblastic disease. Obstet Gynecol Clin North Am 15 (3): 531-43, 1988.
[PUBMED Abstract]
Back to Top Poor-Prognosis Metastatic Gestational Trophoblastic Tumors
Patients with any of the high-risk factors fall into this category. Patients
with a WHO score greater than eight are considered to be especially (“ultra”)
high-risk. Therapy needs to be instituted quickly and should consist of
multiple-agent chemotherapy. Additional therapy (including radiation to central nervous system
metastases and adjuvant surgery) is often necessary. These patients should be
treated at a regional Trophoblastic Disease Center or by a physician with prior
experience in treating poor-risk patients. Radiation to liver metastasis is
contraindicated since it has no clear value and leads to myelosuppression that
may make administration of cytotoxic chemotherapy more difficult.
Standard treatment options:
For patients with a WHO prognostic score less than eight:
-
EMA-CO: etoposide plus methotrexate plus dactinomycin and vincristine plus
cyclophosphamide.[1-3] A dose-intensive regimen, EMA-CE, in
which etoposide and cisplatin are substituted for vincristine and cyclophosphamide of the EMA-CO regimen, may offer additional benefits.[4]
For patients with a WHO prognostic score greater than eight:
- EMA-CO.[1] A dose-intensive regimen, EMA-CE, may offer additional
benefits.[4]
Other regimens that may produce similar outcome but have been studied less
extensively or are in less common use include:
- APE: dactinomycin plus cisplatin plus etoposide. [5]
- PVB: cisplatin plus vinblastine plus bleomycin. [6]
- PEBA: cisplatin plus etoposide plus bleomycin plus adriamycin. [7]
- Ifosfamide plus carboplatin plus etoposide with autologous bone marrow
transplant. [8]
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with poor prognosis metastatic gestational trophoblastic tumor. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
References
-
Soper JT, Evans AC, Clarke-Pearson DL, et al.: Alternating weekly chemotherapy with etoposide-methotrexate-dactinomycin/cyclophosphamide-vincristine for high-risk gestational trophoblastic disease. Obstet Gynecol 83 (1): 113-7, 1994.
[PUBMED Abstract]
-
Newlands ES, Bagshawe KD, Begent RH, et al.: Results with the EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) regimen in high risk gestational trophoblastic tumours, 1979 to 1989. Br J Obstet Gynaecol 98 (6): 550-7, 1991.
[PUBMED Abstract]
-
Bower M, Newlands ES, Holden L, et al.: EMA/CO for high-risk gestational trophoblastic tumors: results from a cohort of 272 patients. J Clin Oncol 15 (7): 2636-43, 1997.
[PUBMED Abstract]
-
Surwit EA, Childers JM: High-risk metastatic gestational trophoblastic disease. A new dose-intensive, multiagent chemotherapeutic regimen. J Reprod Med 36 (1): 45-8, 1991.
[PUBMED Abstract]
-
Theodore C, Azab M, Droz JP, et al.: Treatment of high-risk gestational trophoblastic disease with chemotherapy combinations containing cisplatin and etoposide. Cancer 64 (9): 1824-8, 1989.
[PUBMED Abstract]
-
Azab M, Droz JP, Theodore C, et al.: Cisplatin, vinblastine, and bleomycin combination in the treatment of resistant high-risk gestational trophoblastic tumors. Cancer 64 (9): 1829-32, 1989.
[PUBMED Abstract]
-
Chen LP, Cai SM, Fan JX, et al.: PEBA regimen (cisplatin, etoposide, bleomycin, and adriamycin) in the treatment of drug-resistant choriocarcinoma. Gynecol Oncol 56 (2): 231-4, 1995.
[PUBMED Abstract]
-
Lotz JP, André T, Donsimoni R, et al.: High dose chemotherapy with ifosfamide, carboplatin, and etoposide combined with autologous bone marrow transplantation for the treatment of poor-prognosis germ cell tumors and metastatic trophoblastic disease in adults. Cancer 75 (3): 874-85, 1995.
[PUBMED Abstract]
Back to Top Recurrent Gestational Trophoblastic Tumors
Recurrent disease indicates failure of prior chemotherapy unless initial
therapy was surgery alone. A study found recurrence of disease in 2.5% of
patients with nonmetastatic disease, 3.7% of patients with good-prognosis
metastatic disease, and 13% of patients with poor-prognosis metastatic
disease.[1] All recurrences were within 36 months of remission (85% before 18
months). Prior chemotherapy failure automatically places the patient into the
high-risk (poor prognosis) category. These patients should be treated with
aggressive chemotherapy. For resistant high-risk gestational trophoblastic tumors (GTTs), combinations of
etoposide, cisplatin, and either dactinomycin or bleomycin have shown promising
results.[2,3] A patient who has failed primary surgical therapy is generally
treated with single-agent chemotherapy unless one of the poor-prognosis factors
that requires combination chemotherapy supervenes.
A select group of patients with chemotherapy-resistant and clinically
detectable GTT may benefit from salvage
surgery.[4]
When central nervous system metastases are identified, whole brain radiation
therapy (30 Gy in 2 Gy fractions) is given simultaneously with the
initiation of systemic chemotherapy. Approximately 50% to 60% of patients will
achieve sustained remission using this treatment approach. The outcome for
women presenting with hepatic metastases from GTT disease
is poor with an even worse prognosis if cerebral metastases are also
present.[5,6] Chemotherapy with ifosfamide, carboplatin, and etoposide may be
considered for patients with recurrent GTTs
metastatic to the brain.[7]
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent gestational trophoblastic tumor. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
References
-
Mutch DG, Soper JT, Babcock CJ, et al.: Recurrent gestational trophoblastic disease. Experience of the Southeastern Regional Trophoblastic Disease Center. Cancer 66 (5): 978-82, 1990.
[PUBMED Abstract]
-
Theodore C, Azab M, Droz JP, et al.: Treatment of high-risk gestational trophoblastic disease with chemotherapy combinations containing cisplatin and etoposide. Cancer 64 (9): 1824-8, 1989.
[PUBMED Abstract]
-
Surwit EA: Management of high-risk gestational trophoblastic disease. J Reprod Med 32 (9): 657-62, 1987.
[PUBMED Abstract]
-
Lehman E, Gershenson DM, Burke TW, et al.: Salvage surgery for chemorefractory gestational trophoblastic disease. J Clin Oncol 12 (12): 2737-42, 1994.
[PUBMED Abstract]
-
Small W Jr, Lurain JR, Shetty RM, et al.: Gestational trophoblastic disease metastatic to the brain. Radiology 200 (1): 277-80, 1996.
[PUBMED Abstract]
-
Crawford RA, Newlands E, Rustin GJ, et al.: Gestational trophoblastic disease with liver metastases: the Charing Cross experience. Br J Obstet Gynaecol 104 (1): 105-9, 1997.
[PUBMED Abstract]
-
Piamsomboon S, Kudelka AP, Termrungruanglert W, et al.: Remission of refractory gestational trophoblastic disease in the brain with ifosfamide, carboplatin, and etoposide (ICE): first report and review of literature. Eur J Gynaecol Oncol 18 (6): 453-6, 1997.
[PUBMED Abstract]
Back to Top Get More Information From NCI
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Back to Top Changes to This Summary (12/05/2007)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Added Purpose of This PDQ Summary as a new section.
Back to Top More Information
About PDQ
Additional PDQ Summaries
Important:
This information is intended mainly for use by doctors and other health care professionals. If you have questions about this topic, you can ask your doctor, or call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).
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