Clinical aspects of gestational trophoblastic disease: A review based partly on 25-year experience of a statewide registry

Khoo, Soo-Keat (2003) Clinical aspects of gestational trophoblastic disease: A review based partly on 25-year experience of a statewide registry. Australian & New Zealand Journal of Obstetrics & Gynaecology, 43 4: 280-289. doi:10.1046/j.0004-8666.2003.00091.x


Author Khoo, Soo-Keat
Title Clinical aspects of gestational trophoblastic disease: A review based partly on 25-year experience of a statewide registry
Journal name Australian & New Zealand Journal of Obstetrics & Gynaecology   Check publisher's open access policy
ISSN 0004-8666
Publication date 2003-01-01
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1046/j.0004-8666.2003.00091.x
Open Access Status Not Open Access
Volume 43
Issue 4
Start page 280
End page 289
Total pages 10
Editor M. Humphrey
Place of publication Carlton South, Australia
Publisher Blackwell Publishing Asia
Language eng
Subject C1
321014 Obstetrics and Gynaecology
730201 Women's health
Abstract Background: Gestational trophoblastic disease is a fascinating group of pregnancy disorders characterised by abnormal proliferation of trophoblast, ranging from benign to malignant. Because the disease is uncommon, there is a need to formulate management with the assistance of collective information. Methodology: A review of available information from English written literature was undertaken especially data reported by registries around the world (Charing Cross Hospital in England, the North-western University and the New England area in the USA as well as our own experience in Queensland, Australia). Where possible, collated data from relevant studies were analysed to answer some of the questions posed in clinical practice, with reference to metastatic disease to liver and brain, twinning of molar gestation and coexisting fetus, and placental-site tumour. Results: We found that molar gestation can be classified according to its clinical presentation which influences the time taken to reach human chorionic gonadotropin (HCG) 'negativity' and the risk of persisting disease. Categorisation of risk is the basis for choice of chemotherapy to achieve good outcomes. Metastases to liver and brain remain problems in management; the development of 'new' metastases during chemotherapy is a very poor prognostic factor. In the variant of twinning with molar gestation and coexisting fetus, it is important to elucidate the fetal karyotype in planning management: a 69XXX fetus is not salvageable but a normal 46XX or 46XY fetus faces the prospect of early preterm delivery. The placental-site tumour is very rare; localised disease is curable by surgery; chemotherapy is less effective in disseminated disease. From collated worldwide data, the recurrence rate after one mole is 1.3% and after two or more is 20%. Reproductive outcome in subsequent pregnancies, even after multidrug chemotherapy, is not different from the general population. Because of the increased risk long-term of second tumours after multidrug chemotherapy a closer surveillance of these patients is necessary Conclusion: In general, the disease in its persisting or malignant form is 'a cancer model par excellence' because of an identifiable precursor condition, a reliable HCG marker, and sensitivity of the disease to cytotoxic drugs. With current management, retention of fertility is possible and normal reproductive outcome assured.
Keyword Obstetrics & Gynecology
Partial Hydatidiform Mole
Central-nervous-system
Dose Methotrexate
Folinic Acid
Follow-up
Chemotherapy
Pregnancy
Tumors
Risk
Choriocarcinoma
Q-Index Code C1

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Excellence in Research Australia (ERA) - Collection
2004 Higher Education Research Data Collection
School of Medicine Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 5 times in Thomson Reuters Web of Science Article | Citations
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Created: Wed, 15 Aug 2007, 11:47:38 EST