title: Optimal management of low-risk gestational trophoblastic neoplasia.
abstract: Low-risk gestational trophoblastic neoplasia is a highly curable form of gestational trophoblastic neoplasia that arises largely from molar pregnancy and, on rare occasions, from other types of gestations. Risk is defined as the risk of developing drug resistance as determined by the WHO Prognostic Scoring System. All patients with non-metastatic disease and patients with risk scores <7 are considered to have low-risk disease. The sequential use of methotrexate and actinomycin D is associated with a complete remission rate of 80%. The most commonly utilized regimen for the treatment of patients resistant to single-agent chemotherapy is a multiagent regimen consisting of etoposide, methotrexate, actinomycin D, vincristine and cyclophosphamide. The measurement of human chorionic gonadotropin provides an accurate and reliable tumor marker for diagnosis, monitoring the effects of chemotherapy and follow-up to determine recurrence. Pregnancy is allowed after 12 months of normal serum tumor marker. Pregnancy outcomes are similar to those of normal population.
authors.affiliation: a 1 The New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA.|b 2 Brigham, and Women's Hospital, Division of Gynecologic Oncology, 75 Francis Street, Boston, MA 02115, USA.
authors.forename: Donald P
authors.initials: DP
authors.lastname: Goldstein
authors.affiliation: a 1 The New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA.|b 2 Brigham, and Women's Hospital, Division of Gynecologic Oncology, 75 Francis Street, Boston, MA 02115, USA.
authors.forename: Ross S
authors.initials: RS
authors.lastname: Berkowitz
authors.affiliation: a 1 The New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA.|b 2 Brigham, and Women's Hospital, Division of Gynecologic Oncology, 75 Francis Street, Boston, MA 02115, USA.
authors.forename: Neil S
authors.initials: NS
authors.lastname: Horowitz
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000494:pharmacology / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood; D006063:Chorionic Gonadotropin / Q000097:blood*; D019008:Drug Resistance, Neoplasm; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D011247:Pregnancy; D012306:Risk
chemical_list: D014408:Biomarkers, Tumor; D006063:Chorionic Gonadotropin
keywords: EMACO; actinomycin D; gestational trophoblastic disease; gestational trophoblastic neoplasia; methotrexate; molar pregnancy; non-metastatic disease; sequential chemotherapy; subsequent pregnancy