title: Formalised consensus of the European Organisation for Treatment of Trophoblastic Diseases on management of gestational trophoblastic diseases.
abstract: Gestational trophoblastic disease (GTD) is a spectrum of cellular proliferations arising from trophoblast. Their invasive and metastatic potential sometimes requires chemotherapy and/or surgery. Current management is generally associated with favourable prognosis. Therefore, treatments must be chosen according to the desire for further childbearing of each patient. The European Organisation for Treatment of Trophoblastic Diseases (EOTTD) is dedicated to optimise diagnosis, treatment, follow-up and research in GTD by bringing together knowledge of clinicians and researchers from 29 countries working in the field of GTD in Europe. This study assessed the level of agreement among an expert panel of the EOTTD in order to rationalise the management of patients in Europe. The RAND/UCLA Appropriateness Method was used to combine the best available scientific evidence with the collective judgment of experts to yield a statement regarding the appropriateness of performing a procedure at the level of patient-specific symptoms, medical history and test results. There was an agreement for 54 statements while the experts showed a disagreement for two statements. As there is little evidence from randomised trials on which to base recommendations about management of GTD, many of these recommendations are based on expert opinion derived from changes in management fact that have improved outcomes from nearly 100% fatality to nearly 100% cure rates. However, a large agreement among experts is invaluable to the individual clinician who is struggling to decide whether a fertility-sparing treatment of hydatidiform mole or a low-risk GTN can be chosen and how it must be conducted.
authors.affiliation: University of Lyon 1, University Hospital Lyon Sud, Department of Gynaecological Surgery and Oncology, Obstetrics, Pierre Bénite, France; French Centre for Trophoblastic Diseases, University Hospital Lyon Sud, Pierre Bénite, France. Electronic address: pierre-adrien.bolze@chu-lyon.fr.
authors.forename: Pierre-Adrien
authors.initials: PA
authors.lastname: Bolze
authors.affiliation: University of Lyon 1, University Hospital Lyon Sud, Department of Gynaecological Surgery and Oncology, Obstetrics, Pierre Bénite, France; French Centre for Trophoblastic Diseases, University Hospital Lyon Sud, Pierre Bénite, France. Electronic address: jocelyne.attia@chu-lyon.fr.
authors.forename: Jocelyne
authors.initials: J
authors.lastname: Attia
authors.affiliation: French Centre for Trophoblastic Diseases, University Hospital Lyon Sud, Pierre Bénite, France; University of Lyon 1, University Hospital Femme Mere Enfant, Department of Prenatal Diagnosis, Bron, France. Electronic address: jerome.massardier@chu-lyon.fr.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Massardier
authors.affiliation: Imperial College London and Charing Cross Gestational Trophoblastic Disease Centre, Imperial College NHS Healthcare Trust, London, UK. Electronic address: m.seckl@imperial.ac.uk.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Seckl
authors.affiliation: Dutch Working Party on Trophoblastic Disease, Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. Electronic address: leon.massuger@radboudumc.nl.
authors.forename: Leon
authors.initials: L
authors.lastname: Massuger
authors.affiliation: Dutch Working Party on Trophoblastic Disease, Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. Electronic address: nienke@vantrommel.nl.
authors.forename: Nienke
authors.initials: N
authors.lastname: van Trommel
authors.affiliation: Department of Gynaecology and Obstetrics, Aarhus University Hospital, Skejby, Denmark. Electronic address: isa.niemann@dadlnet.dk.
authors.forename: Isa
authors.initials: I
authors.lastname: Niemann
authors.affiliation: French Centre for Trophoblastic Diseases, University Hospital Lyon Sud, Pierre Bénite, France. Electronic address: touria.hajri@chu-lyon.fr.
authors.forename: Touria
authors.initials: T
authors.lastname: Hajri
authors.affiliation: University of Lyon 1, Pôle IMER, Lyon, France. Electronic address: anne-marie.schott-pethelaz@chu-lyon.fr.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Schott
authors.affiliation: University of Lyon 1, University Hospital Lyon Sud, Department of Gynaecological Surgery and Oncology, Obstetrics, Pierre Bénite, France; French Centre for Trophoblastic Diseases, University Hospital Lyon Sud, Pierre Bénite, France. Electronic address: francois.golfier@chu-lyon.fr.
authors.forename: François
authors.initials: F
authors.lastname: Golfier
mesh_terms: D003299:Cooperative Behavior; D003697:Delphi Technique; D005060:Europe; D019317:Evidence-Based Medicine / Q000592:standards*; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007391:International Cooperation; D008495:Medical Oncology / Q000592:standards*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011379:Prognosis
keywords: Choriocarcinoma; Epithelioid trophoblastic tumour; Gestational trophoblastic disease; Human chorionic gonadotropin; Hydatidiform mole; Molar pregnancy; Placental site trophoblastic tumour; Rare cancers