Skip to main content

Advertisement

SpringerLink
Log in

Gestational trophoblastic neoplasia: The management of relapsing patients and other recent advances

  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

The treatment of gestational trophoblastic neoplasia (GTN) represents one of the modern success stories in cancer medicine. Early diagnosis, effective treatments, monitoring of response with a series of serum human chorionic gonadotropin levels, and centralized care have all contributed to this success. Nevertheless, some patients relapse after initial chemotherapy. This review discusses the routine management of GTN and how to treat relapsed disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. World Health Organization: Gestational Trophoblastic Diseases, Technical Report series 692. Geneva, Switzerland: WHO; 1983:7–81.

    Google Scholar 

  2. Jacobs PA, Hunt PA, Matsuura JS, et al.: Complete and partial hydatidiform mole in Hawaii: cytogenetics, morphology and epidemiology. Br J Obstet Gynaecol 1982, 89:258–266.

    PubMed  CAS  Google Scholar 

  3. Steigrad SJ: Epidemiology of gestational trophoblastic diseases. Best Pract Res Clin Obstet Gynaecol 2003, 17:837–847.

    Article  PubMed  Google Scholar 

  4. Tidy JA, Gillespie AM, Bright N, et al.: Gestational trophoblastic disease: a study of mode of evacuation and subsequent need for treatment with chemotherapy. Gynecol Oncol 2000, 78:309–312.

    Article  PubMed  CAS  Google Scholar 

  5. Seckl MJ, Fisher RA, Salerno G, et al.: Choriocarcinoma and partial hydatidiform moles. Lancet 2000, 356:36–39.

    Article  PubMed  CAS  Google Scholar 

  6. Seckl MJ, Fillmore R, Foskett M, et al.: Routine terminations of pregnancy: Should we screen for gestational trophoblastic neoplasia. Lancet 2004, 364:705–707.

    Article  PubMed  Google Scholar 

  7. Cole LA, Shahabi S, Butler SA, et al.: Utility of commonly used commercial human chorionic gonadotropin immunoassays in the diagnosis and management of trophoblastic diseases. Clin Chem 2001, 47:308–315.

    PubMed  CAS  Google Scholar 

  8. Agarwal R, Strickland S, McNeish IA, et al.: Doppler ultrasonography of the uterine artery and the response to chemotherapy in patients with gestational trophoblastic tumors. Clin Cancer Res 2002, 8:1142–1147.

    PubMed  Google Scholar 

  9. Lim AK, Agarwal R, Seckl MJ, et al.: Embolization of residual uterine vascular malformations in patients with gestational trophoblastic tumours. Radiology 2002, 222:640–644.

    Article  PubMed  Google Scholar 

  10. Seckl MJ, Rustin GJ, Newlands ES, et al.: Pulmonary embolism, pulmonary hypertension, and choriocarcinoma. Lancet 1991, 338:1313–1315.

    Article  PubMed  CAS  Google Scholar 

  11. Bagshawe KD: Risk and prognostic factors in trophoblastic neoplasia. Cancer 1976, 38:1373–1385.

    Article  PubMed  CAS  Google Scholar 

  12. Kohorn EI: The new FIGO 2000 staging and risk factor scoring system for gestational trophoblastic disease: description and critical assessment. Int J Gynecol Cancer 2001, 11:73–77.

    Article  PubMed  CAS  Google Scholar 

  13. Boshoff C, Begent RH, Oliver RT, et al.: Secondary tumours following etoposide containing therapy for germ cell cancer. Ann Oncol 1995, 6:35–40.

    PubMed  CAS  Google Scholar 

  14. Wong LC, Ngan HY, Cheng DK, Ng TY: Methotrexate infusion in low-risk gestational trophoblastic disease. Am J Obstet Gynecol 2000, 183:1579–1582.

    Article  PubMed  CAS  Google Scholar 

  15. Kwon JS, Elit L, Mazurka J, Moens F, Schmuck ML: Weekly intravenous methotrexate with folinic acid for nonmetastatic gestational trophoblastic neoplasia. Gynecol Oncol 2001, 82:367–370.

    Article  PubMed  CAS  Google Scholar 

  16. McNeish IA, Strickland S, Holden L, et al.: Low risk persistent gestational trophoblastic disease: outcome following initial treatment with low-dose methotrexate and folinic acid, 1992–2000. J Clin Oncol 2002, 20:1838–1844. This paper describes the single-center experience of efficacy, relapse rates, and salvage therapies for patients initially treated with methotrexate and folinic acid for low-risk GTN.

    Article  PubMed  CAS  Google Scholar 

  17. Rustin GJ, Newlands ES, Lutz JM, et al.: Combination but not single agent methotrexate chemotherapy for gestational trophoblastic tumours (GTT) increases the incidence of second tumours. J Clin Oncol 1996, 14:2769–2773.

    PubMed  CAS  Google Scholar 

  18. Kohorn EI: Is lack of response to single-agent chemotherapy in gestational trophoblastic disease associated with dose scheduling or chemotherapy resistance? Gynecol Oncol 2002, 85:36–39.

    Article  PubMed  CAS  Google Scholar 

  19. Bower M, Newlands ES, Holden L, et al.: EMA/CO for high-risk gestational trophoblastic tumours: results from a cohort of 272 patients. J Clin Oncol 1997, 15:2636–2643.

    PubMed  CAS  Google Scholar 

  20. Newlands ES, Holden L, Seckl MJ, et al.: Management of brain metastases in patients with high-risk gestational trophoblastic tumors. J Reprod Med 2002, 47:465–471. This paper summarizes the largest single-center experience for the management of GTN involving the CNS.

    PubMed  CAS  Google Scholar 

  21. Schink JC, Singh DK, Rademaker AW, et al.: Etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine for the treatment of metastatic, high-risk gestational trophoblastic disease. Obstet Gynecol 1992, 80:817–820.

    PubMed  CAS  Google Scholar 

  22. Quinn M, Murray J, Friedlander M, et al.: EMACO in high risk gestational trophoblast disease: the Australian experience. Gestational Trophoblast Subcommittee, Clinical Oncological Society of Australia. Aust N Z J Obstet Gynaecol 1994, 34:90–92.

    PubMed  CAS  Google Scholar 

  23. Kim SJ, Bae SN, Kim JH, et al.: Effects of multiagent chemotherapy and independent risk factors in the treatment of high-risk GTT: 25 years experiences of KRI-TRD. Int J Gynaecol Obstet 1998, 60(Suppl 1):S85-S96.

    Article  PubMed  Google Scholar 

  24. Lurain JR: Management of high-risk gestational trophoblastic disease. J Reprod Med 1998, 43:44–52.

    PubMed  CAS  Google Scholar 

  25. Xiang Y, Yang X, Han S: Methotrexate combined chemotherapy for chemorefractory gestational trophoblastic tumour [in Chinese]. Zhonghua Fu Chan Ke Za Zhi 1999, 34:97–100.

    PubMed  CAS  Google Scholar 

  26. Dobson LS, Lorigan PC, Coleman RE, Hancock BW: Persistent gestational trophoblastic disease: results of MEA (methotrexate, etoposide and dactinomycin) as first-line chemotherapy in high risk disease and EA (etoposide and dactinomycin) as second-line therapy for low risk disease. Br J Cancer 2000, 82:1547–1552.

    Article  PubMed  CAS  Google Scholar 

  27. Matsui H, Suzuka K, Iitsuka Y, et al.: Combination chemotherapy with methotrexate, etoposide, and actinomycin D for high-risk gestational trophoblastic tumors. Gynecol Oncol 2000, 78:28–31.

    Article  PubMed  CAS  Google Scholar 

  28. Papadopoulos AJ, Foskett M, Seckl MJ, et al.: Twenty-five years’ clinical experience of placental site trophoblastic tumors. J Reprod Med 2002, 47:460–464. The optimal management for PSTT will probably never be defined, but this paper provides substantial insight into how this rare tumor should be managed and which prognostic factors are likely to be of key importance.

    PubMed  Google Scholar 

  29. Newlands ES: The management of recurrent and drug-resistant gestational trophoblastic neoplasia (GTN). Best Pract Res Clin Obstet Gynaecol 2003, 17:905–923.

    Article  PubMed  CAS  Google Scholar 

  30. Newlands ES, Mulholland PJ, Holden L, et al.: Etoposide and cisplatin/etoposide, methotrexate, and actinomycin D (EMA) chemotherapy for patients with high-risk gestational trophoblastic tumors refractory to EMA/cyclophosphamide and vincristine chemotherapy and patients presenting with metastatic placental site trophoblastic tumors. J Clin Oncol 2000, 18:854–859. The choice of effective salvage regimens for patients relapsing from high-risk GTN is unclear. This paper describes the single-center use of cisplatin in the EP/EMA schedule. The results indicate that this is likely to be the best regimen either alone or in combination with surgical removal of known sites of active disease. An international randomized phase II/III trial is now required.

    PubMed  CAS  Google Scholar 

  31. Gordon AN, Kavanagh JJ, Gershenson DM, et al.: Cisplatin, vinblastine, and bleomycin combination therapy in resistant gestational trophoblastic disease. Cancer 1986, 58:1407–1410.

    Article  PubMed  CAS  Google Scholar 

  32. DuBeshter B, Berkowitz RS, Goldstein DP, Bernstein M: Vinblastine, cisplatin and bleomycin as salvage therapy for refractory high-risk metastatic gestational trophoblastic disease. J Reprod Med 1989, 34:189–192.

    PubMed  CAS  Google Scholar 

  33. Azab M, Droz JP, Theodore C, et al.: Cisplatin, vinblastine, and bleomycin combination in the treatment of resistant high-risk gestational trophoblastic tumors. Cancer 1989, 64:1829–1832.

    Article  PubMed  CAS  Google Scholar 

  34. Soper JT, Evans AC, Rodriguez G, et al.: Etoposide-platin combination therapy for chemorefractory gestational trophoblastic disease. Gynecol Oncol 1995, 56:421–424.

    Article  PubMed  CAS  Google Scholar 

  35. Matsui H, Iitsuka Y, Suzuka K, et al.: Salvage chemotherapy for high-risk gestational trophoblastic tumor. J Reprod Med 2004, 49:438–442.

    PubMed  Google Scholar 

  36. Jones WB, Schneider J, Shapiro F, Lewis JL Jr: Treatment of resistant gestational choriocarcinoma with taxol: a report of two cases. Gynecol Oncol 1996, 61:126–130.

    Article  PubMed  CAS  Google Scholar 

  37. Gerson R, Serrano A, Del Carmen Bello M, et al.: Response of choriocarcinoma to paclitaxel: case report and review of resistance. Eur J Gynaecol Oncol 1997, 18:108–110.

    PubMed  CAS  Google Scholar 

  38. McNeish IA, Kanfer EJ, Haynes R, et al.: Paclitaxel-containing high-dose chemotherapy for relapsed or refractory testicular germ cell tumours. Br J Cancer 2004, 90:1169–1175.

    Article  PubMed  CAS  Google Scholar 

  39. Pandian Z, Seckl MJ, Smith R, Lees DA: Gestational choriocarcinoma: an unusual presentation with response to gemcitabine and surgery. BJOG 2004, 111:382–384.

    Article  PubMed  Google Scholar 

  40. Giacalone PL, Benos P, Donnadio D, Laffargue F: High-dose chemotherapy with autologous bone marrow transplantation for refractory metastatic gestational trophoblastic disease. Gynaecol Oncol 1995, 58:383–385.

    Article  CAS  Google Scholar 

  41. van Besien K, Verschraegen C, Mehra R, et al.: Complete remission of refractory gestational trophoblastic disease with brain metastases treated with multicycle ifosfamide, carboplatin and etoposide (ICE) and stem cell rescue. Gynaecol Oncol 1997, 65:366–369.

    Article  Google Scholar 

  42. Knox S, Brooks SE, Wong-You-Cheong J, et al.: Choriocarcinoma and epithelial trophoblastic tumor: successful treatment of relapse with hysterectomy and highdose chemotherapy with peripheral stem cell support: a case report. Gynecol Oncol 2002, 85:204–208.

    Article  PubMed  Google Scholar 

  43. Athanassiou A, Begent RH, Newlands ES, et al.: Central nervous system metastases of choriocarcinoma: 23 years’ experience at Charing Cross Hospital. Cancer 1983, 52:1728–1735.

    Article  PubMed  CAS  Google Scholar 

  44. Lo SK, Montgomery JN, Blagden S, et al.: Reducing incidence of headache after lumbar puncture and intrathecal cytotoxics. Lancet 1999, 353:2038–2039.

    Article  PubMed  CAS  Google Scholar 

  45. Rustin GJ, Newlands ES, Begent RH, et al.: Weekly alternating chemotherapy (EMA/CO) for treatment of central nervous systems of choriocarcinoma. J Clin Oncol 1989, 7:900–903.

    PubMed  CAS  Google Scholar 

  46. Altintas A, Vardar MA: Central nervous system involvement in gestational trophoblastic neoplasia. Eur J Gynaecol Oncol 2001, 22:154–156.

    PubMed  CAS  Google Scholar 

  47. Small W Jr, Lurain JR, Shetty RM, et al.: Gestational trophoblastic disease metastatic to the brain. Radiology 1996, 200:277–280.

    PubMed  Google Scholar 

  48. Schechter NR, Mychalczak B, Jones W, Spriggs D: Prognosis of patients treated with whole-brain radiation therapy for metastatic gestational trophoblastic disease. Gynecol Oncol 1998, 68:183–192.

    Article  PubMed  CAS  Google Scholar 

  49. Feltmate CM, Genest DR, Goldstein DP, Berkowitz RS: Advances in the understanding of placental site trophoblastic tumor. J Reprod Med 2002, 47:337–341.

    PubMed  Google Scholar 

  50. Tuncer ZS, Vegh GL, Fulop V, Genest DR, et al.: Expression of epidermal growth factor receptor-related family products in gestational trophoblastic diseases and normal placenta and its relationship with development of postmolar tumor. Gynecol Oncol 2000, 77:389–393.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Trophoblastic Disease Centre, Department of Medical Oncology, Charing Cross Hospital, Fulham Palace Road, W6 8RF, London, UK

    Naveed Sarwar MD, Edward S. Newlands MD, PhD & Michael J. Seckl MD, PhD

Authors
  1. Naveed Sarwar MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Edward S. Newlands MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael J. Seckl MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sarwar, N., Newlands, E.S. & Seckl, M.J. Gestational trophoblastic neoplasia: The management of relapsing patients and other recent advances. Curr Oncol Rep 6, 476–482 (2004). https://doi.org/10.1007/s11912-004-0079-1

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11912-004-0079-1

Keywords

Search

Navigation