The management of recurrent and drug-resistant gestational trophoblastic neoplasia (GTN).
Gestational trophoblastic neoplasia (GTN) comprises a spectrum of disease from low-risk disease which can be cured with simple relatively non-toxic treatment, to extremely aggressive tumours which require specialized management. The prognostic variables in patients with GTN are different from those in other gynaecological malignancies, and the major adverse prognostic variables include long interval from antecedent pregnancy, high concentrations of the pregnancy hormone, human chorionic gonadotrophin, metastases in brain and liver and failure of prior treatment. Patients who relapse after their prior treatment can also be categorized into different risk groups. Salvage treatment can vary from single agent actinomycin D to combination chemotherapy and, in selected cases, surgery. With appropriate management, the majority of patients can achieve long-term remission and, in most cases, preserve fertility. The late side-effects of more intensive treatment are a small risk of inducing second tumours and also of bringing forward the age of menopause.
Newlands
E S
ES
Treatment and Screening Centre for Gestational and Trophoblastic Neoplasia, Charing Cross Hospital, Fulham Palace Rd, W6 8RF London, UK. e.newlands@lc.ac.uk
D000970:Antineoplastic Agents / Q000009:adverse effects; D016543:Central Nervous System Neoplasms / Q000556:secondary; D006063:Chorionic Gonadotropin / Q000097:blood; D019008:Drug Resistance, Neoplasm; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000188:drug therapy* / Q000235:genetics; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D009367:Neoplasm Staging; D011247:Pregnancy; D011379:Prognosis; D012307:Risk Factors; D016896:Treatment Outcome; D018245:Trophoblastic Tumor, Placental Site / Q000628:therapy; D014594:Uterine Neoplasms / Q000628:therapy
D000970:Antineoplastic Agents; D006063:Chorionic Gonadotropin