eMedicine Specialties > Obstetrics and Gynecology > Gynecologic Oncology

Gestational Trophoblastic Neoplasia: Treatment & Medication

Author: Enrique Hernandez, MD, FACOG, FACS, Chairman, Department of Obstetrics and Gynecology, Director of Gynecologic Oncology, Abraham Roth Professor of Obstetrics, Gynecology and Reproductive Science, Professor of Pathology, Temple University Hospital, Temple University School of Medicine
Contributor Information and Disclosures

Updated: Sep 24, 2008

Treatment

Medical Care

  • Patients with gestational trophoblastic disease (GTD) do not require medical therapy. Because 20% of patients with hydatidiform mole develop malignant disease, such as persistent hydatidiform mole with or without metastasis, some have suggested the use of a prophylactic dose of methotrexate in noncompliant patients.39,40 However, observing patients with weekly serum hCG levels is preferable, and only patients with rising or plateauing titers, as occurs in patients with gestational trophoblastic neoplasia (GTN), should be treated with chemotherapy.1
  • Patients with nonmetastatic GTN or metastatic low-risk GTN are treated with single-agent chemotherapy.41,42,43,44,45,46 Many in the United States prefer methotrexate. However, actinomycin D can be used in patients with poor liver function. During treatment, the serum hCG levels are monitored every week. One additional course of chemotherapy is administered after a normal serum hCG level. After 3-4 normal serum hCG levels, the levels are observed once per month for 1 year. A switch from methotrexate to actinomycin D is made if the patient receiving methotrexate for nonmetastatic or metastatic low-risk GTN develops rising or plateauing serum hCG levels.
  • A randomized clinical trial comparing 30 mg/m2 methotrexate given weekly to patients with low-risk GTN versus 1.25 mg/m2 of actinomycin D given every other week showed a higher complete response rate with actinomycin D.47
  • Patients with high-risk metastatic GTN are subdivided into 2 groups: those with a WHO score of less than 7 and those with a score of 7 or higher and who are at high risk of therapy failure.  
    • Patients with a WHO score of less than 7 can be treated with single-agent chemotherapy (methotrexate or actinomycin) because their chances of achieving a cure are high.38 The authors have treated patients with high-risk metastatic disease, based on the clinical classification, and a WHO score of less than 7 with a combination of methotrexate, actinomycin D, and cyclophosphamide. This is known as the MAC regimen. This chemotherapeutic regimen is administered every 19-21 days (from day 1 of the previous chemotherapy cycle) until the serum hCG titers normalize.2,48 In patients with a low WHO score, one additional course of chemotherapy is administered after a normal serum hCG level.
    • Patients with WHO scores of 7 or higher are treated with a combination of etoposide, methotrexate, and actinomycin D administered in the first week of a 2-week cycle and cyclophosphamide and vincristine (Oncovin) administered in the second week.49,50,51 This is known as the EMA-CO regimen. Some substitute cisplatin and etoposide for cyclophosphamide and vincristine during the second week. This is known as the EMA-CE regimen.52 Some reserve the EMA-CE regimen for patients in whom EMA-CO fails. Two additional courses of EMA-CO or EMA-CE are administered after a normal serum hCG level. Patients with metastasis to the brain receive whole brain irradiation (3000 cGy) in combination with chemotherapy.53,54,55 Corticosteroids (dexamethasone) with systemic effect are administered to reduce brain edema. Patients with liver metastasis are considered for liver irradiation (2000 cGy).56
    • After achieving 3-4 consecutive weekly normal serum hCG levels, patients with stage IV GTN are observed with monthly serum hCG levels for 2 years. If the levels begin to rise during follow-up, the patient is evaluated for possible intervening pregnancy, or persistent or recurrent disease.

Surgical Care

  • A hysterectomy may be necessary in case of uncontrolled vaginal bleeding. Hysterectomy may reduce the total number of chemotherapy cycles needed to achieve remission.36,37
  • Uterine or hypogastric artery ligation or embolization of feeding vessels may be needed to control hemorrhage. Hepatic artery embolization has been used successfully to control hemorrhage from hepatic metastases.25
  • A repeat D&C in the presence of persistent tissue on pelvic ultrasonography may reduce the number of chemotherapy cycles needed to achieve remission.57
  • Craniotomy may be needed to control bleeding and provide decompression.58,50
  • Resection of solitary metastasis (eg, thoracotomy) or disease within the myometrium may help achieve a remission.59,60,61

Consultations

A gynecologic oncologist experienced in managing GTN should be consulted.

Diet

No restrictions

Activity

No restrictions

Medication

The goals of pharmacotherapy are to reduce morbidity and to eradicate the neoplasm.

Antineoplastics

Gestational trophoblastic tumors are sensitive to many antineoplastic agents, especially those that act in the S phase or the M phase of the cell cycle.


Methotrexate (Folex PFS, Rheumatrex)

Used both as single agent and in multiagent regimens for the treatment of malignant GTN.

Adult

0.4 mg/kg IV/IM qd for 5 d when used as single agent (not to exceed 30 mg)
0.3 mg/kg IV/IM qd for 5 d when used in MAC regimen (not to exceed 15 mg); may repeat 14-16 d after last dose
30-50 mg/m2 IV/IM every week is alternative single-agent regimen
100 mg/m2 IV as 12-h infusion on day 1 of EMA-CO regimen

Pediatric

Children: Not established
Adolescents: Administer as in adults

Salicylates, procarbazine, sulfonamides, and NSAIDs may increase effects and toxicity; folic acid and its derivatives contained in some vitamins may decrease response to MTX; may increase plasma levels of thiopurines; coadministration with etretinate may increase hepatotoxicity of MTX

Documented hypersensitivity; hepatic insufficiency

Pregnancy

X - Contraindicated; benefit does not outweigh risk

Precautions

Monitor liver enzymes and CBC; most common adverse effects are hematologic and gastrointestinal; may cause oral mucositis and hepatic toxicity; liver irradiation can increase hepatotoxicity


Actinomycin D (Dactinomycin)

Intercalates between guanine and cytosine base pairs, inhibiting DNA and RNA synthesis and protein synthesis. Use as single agent or as part of multiagent regimen for treatment of malignant GTN.

Adult

0.01 mg/kg IV qd for 5 d as part of MAC regimen or as single agent (not to exceed 0.5 mg); repeat 14-16 d after last dose.
Alternatively, 1.25 mg/m2 every other week in patients with on-metastatic GTN or low-risk metastatic GTN. 0.5 mg IV on days 1 and 2 in EMA-CO regimen

Pediatric

<6 months: Not recommended
>6 months: Administer as in adults

Concurrent use with liver irradiation or MTX increases risk of developing hepatic toxicity

Documented hypersensitivity; herpes zoster; chickenpox

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Infusion must be IV because it is a vesicant; monitor CBC and liver enzymes (can cause bone marrow depression and hepatotoxicity); premedicate against nausea; unsafe to use in normal pregnancies, especially in first trimester; use as antineoplastic in second and third trimester of pregnancy should be under the supervision of a qualified oncologist and qualified obstetrician after proper patient counseling


Cyclophosphamide (Cytoxan, Neosar)

Chemically related to nitrogen mustards. As alkylating agent, mechanism of action of active metabolites may involve cross-linking of DNA, which may interfere with growth of normal and neoplastic cells. Part of multiagent chemotherapy regimens used to treat high-risk metastatic GTN.

Adult

5 mg/kg IV qd for 5 d as part of MAC regimen (not to exceed 250 mg)
Course is repeated 14-16 d after last dose
600 mg/m2 IV on day 8 of EMA-CO regimen

Pediatric

Administer as in adults

Allopurinol may increase risk of bleeding or infection and enhance myelosuppressive effects of cyclophosphamide; may reduce digoxin serum levels and antimicrobial effects of quinolones; may increase effect of anticoagulants; coadministration with high doses of phenobarbital may increase rate of metabolism and leukopenic activity of cyclophosphamide; thiazide diuretics may prolong cyclophosphamide-induced leukopenia; potentiates effect of succinylcholine

Documented hypersensitivity; severely depressed bone marrow function

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Preinfusion and postinfusion hydration prevents hemorrhagic cystitis; monitor CBC; premedicate against nausea; regularly examine hematologic profile (particularly neutrophils and platelets) to monitor for hematopoietic suppression; regularly examine urine for RBCs, which may precede hemorrhagic cystitis


Etoposide (Toposar, VePesid)

Inhibits topoisomerase II and causes DNA strand breakage, causing cell proliferation to arrest in late S or early G2 portion of cell cycle. One of the drugs in multiagent chemotherapy regimens used to treat patients with high-risk metastatic GTN.

Adult

100 mg/m2 IV on days 1 and 2 of EMA-CO regimen and on day 8 of EMA-CE regimen

Pediatric

Children: Not established
Adolescents: Administer as in adults

May prolong effects of warfarin and increase clearance of MTX

Documented hypersensitivity; intrathecal administration may cause death

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Mix in 500 mL of isotonic sodium chloride solution and infuse over 1 h to prevent hypotension; monitor CBC (can cause severe myelosuppression); premedicate against nausea


Vincristine (Oncovin, Vincasar PFS)

Blocks mitosis; one of the drugs included in multiagent chemotherapy regimens used to treat patients with high-risk metastatic GTN.

Adult

1 mg/m2 IV on day 8 of EMA-CO regimen (not to exceed 2 mg)

Pediatric

Children: Not established
Adolescents: Administer as in adults

Concurrent use with itraconazole can cause earlier onset and/or increase severity of adverse neuromuscular effects; acute pulmonary reaction may occur when administered concurrently with mitomycin-C

Documented hypersensitivity; patients with demyelinating form of Charcot-Marie-Tooth syndrome

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Caution with severe cardiopulmonary or hepatic impairment and preexisting neuromuscular disease; administration must be IV


Cisplatin (Platinol)

Inhibits DNA synthesis and, thus, cell proliferation, by causing DNA cross-links and denaturation of double helix. Effective antineoplastic used in patients with chemotherapy-resistant malignant GTN.

Adult

75-80 mg/m2 IV on day 8 of EMA-CE regimen

Pediatric

Children: Not established
Adolescents: Administer as in adults

May cause decrease in plasma levels of anticonvulsants

Documented hypersensitivity; preexisting renal insufficiency

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Can cause nephrotoxicity and neurotoxicity; monitor serum creatinine and electrolytes; administer prechemotherapy and postchemotherapy hydration; potent emetic; premedicate with combination of antiemetics; hydroxylated cisplatinum is more nephrotoxic than chlorinated cisplatinum; should be mixed in isotonic sodium chloride solution or hypertonic saline for infusion

Vitamins

May be used to alleviate toxic adverse effects of MTX. MTX blocks conversion of uridine to thymidine, one of the building blocks of DNA. Folinic acid provides a methyl group to uridine monophosphate, thus forming thymidine monophosphate, overcoming effects of MTX on tetrahydrofolic acid reductase.


Leucovorin; folinic acid (Wellcovorin)

Used to prevent toxicity from high doses of MTX.

Adult

15 mg PO/IM q12h for 4 doses starting 24 h after administration of MTX as part of EMA-CO and EMA-CE regimens

Pediatric

Administer as in adults

At high doses, may counteract effect of some anticonvulsants (phenobarbital, phenytoin, primidone); increases 5-fluorouracil toxicity

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Do not administer intrathecally or intraventricularly; not to be used for treatment of megaloblastic anemia secondary to vitamin B-12 deficiency

More on Gestational Trophoblastic Neoplasia

Overview: Gestational Trophoblastic Neoplasia
Differential Diagnoses & Workup: Gestational Trophoblastic Neoplasia
Treatment & Medication: Gestational Trophoblastic Neoplasia
Follow-up: Gestational Trophoblastic Neoplasia
Multimedia: Gestational Trophoblastic Neoplasia
References
[ CLOSE WINDOW ]

References

  1. Smith HO, Kohorn E, Cole LA. Choriocarcinoma and gestational trophoblastic disease. Obstet Gynecol Clin North Am. Dec 2005;32(4):661-84. [Medline].

  2. Soper JT. Gestational trophoblastic disease. Obstet Gynecol. Jul 2006;108(1):176-87. [Medline].

  3. Yuen BH, Cannon W. Molar pregnancy in British Columbia: estimated incidence and postevacuation regression patterns of the beta subunit of human chorionic gonadotropin. Am J Obstet Gynecol. Feb 1 1981;139(3):316-9. [Medline].

  4. Goto S, Yamada A, Ishizuka T, et al. Development of postmolar trophoblastic disease after partial molar pregnancy. Gynecol Oncol. Feb 1993;48(2):165-70. [Medline].

  5. Hancock BW, Tidy JA. Current management of molar pregnancy. J Reprod Med. May 2002;47(5):347-54. [Medline].

  6. Watson EJ, Hernandez E, Miyazawa K. Partial hydatidiform moles: a review. Obstet Gynecol Surv. Sep 1987;42(9):540-4. [Medline].

  7. Cheung AN, Khoo US, Lai CY, et al. Metastatic trophoblastic disease after an initial diagnosis of partial hydatidiform mole: genotyping and chromosome in situ hybridization analysis. Cancer. Apr 1 2004;100(7):1411-7. [Medline].

  8. Menczer J, Girtler O, Zajdel L, et al. Metastatic trophoblastic disease following partial hydatidiform mole: case report and literature review. Gynecol Oncol. Aug 1999;74(2):304-7. [Medline].

  9. Lurain JR, Sand PK, Brewer JI. Choriocarcinoma associated with ectopic pregnancy. Obstet Gynecol. Aug 1986;68(2):286-7. [Medline].

  10. Baergen RN, Rutgers JL, Young RH, et al. Placental site trophoblastic tumor: A study of 55 cases and review of the literature emphasizing factors of prognostic significance. Gynecol Oncol. Mar 2006;100(3):511-20. [Medline].

  11. Tsuji Y, Tsubamoto H, Hori M, et al. Case of PSTT treated with chemotherapy followed by open uterine tumor resection to preserve fertility. Gynecol Oncol. Dec 2002;87(3):303-7. [Medline].

  12. Nigam S, Singhal N, Kumar Gupta S, et al. Placental site trophoblastic tumor in a postmenopausal female--a case report. Gynecol Oncol. May 2004;93(2):550-3. [Medline].

  13. Hassadia A, Gillespie A, Tidy J, et al. Placental site trophoblastic tumour: clinical features and management. Gynecol Oncol. Dec 2005;99(3):603-7. [Medline].

  14. Berkowitz BJ, Jones JG, Merkatz IR, et al. Ovarian conservation in placental site trophoblastic tumor. Gynecol Oncol. May 1990;37(2):239-43. [Medline].

  15. Zhao J, Xiang Y, Wan XR, et al. Clinical and pathologic characteristics and prognosis of placental site trophoblastic tumor. J Reprod Med. Dec 2006;51(12):939-44. [Medline].

  16. Papadopoulos AJ, Foskett M, Seckl MJ, et al. Twenty-five years' clinical experience with placental site trophoblastic tumors. J Reprod Med. Jun 2002;47(6):460-4. [Medline].

  17. Grimes DA. Epidemiology of gestational trophoblastic disease. Am J Obstet Gynecol. Oct 1 1984;150(3):309-18. [Medline].

  18. McDonald TW, Ruffolo EH. Modern management of gestational trophoblastic disease. Obstet Gynecol Surv. Feb 1983;38(2):67-83. [Medline].

  19. Palmer JR. Advances in the epidemiology of gestational trophoblastic disease. J Reprod Med. Mar 1994;39(3):155-62. [Medline].

  20. Chakrabarti BK, Mondal NR, Chatterjee T. Gestational trophoblastic tumor at a tertiary level cancer center: a retrospective study. J Reprod Med. Nov 2006;51(11):875-8. [Medline].

  21. Soper JT, Evans AC, Conaway MR, et al. Evaluation of prognostic factors and staging in gestational trophoblastic tumor. Obstet Gynecol. Dec 1994;84(6):969-73. [Medline].

  22. Mutch DG, Soper JT, Babcock CJ, et al. Recurrent gestational trophoblastic disease. Experience of the Southeastern Regional Trophoblastic Disease Center. Cancer. Sep 1 1990;66(5):978-82. [Medline].

  23. Smith HO, Qualls CR, Prairie BA, et al. Trends in gestational choriocarcinoma: a 27-year perspective. Obstet Gynecol. Nov 2003;102(5 Pt 1):978-87. [Medline].

  24. Yingna S, Yang X, Xiuyu Y, et al. Clinical characteristics and treatment of gestational trophoblastic tumor with vaginal metastasis. Gynecol Oncol. Mar 2002;84(3):416-9. [Medline].

  25. Grumbine FC, Rosenshein NB, Brereton HD, et al. Management of liver metastasis from gestational trophoblastic neoplasia. Am J Obstet Gynecol. Aug 15 1980;137(8):959-61. [Medline].

  26. Soper JT, Mutch DG, Chin N, et al. Renal metastases of gestational trophoblastic disease: a report of eight cases. Obstet Gynecol. Nov 1988;72(5):796-8. [Medline].

  27. Fulop V, Mok SC, Berkowitz RS. Molecular biology of gestational trophoblastic neoplasia: a review. J Reprod Med. Jun 2004;49(6):415-22. [Medline].

  28. Fong PY, Xue WC, Ngan HY, et al. Mcl-1 expression in gestational trophoblastic disease correlates with clinical outcome: a differential expression study. Cancer. Jan 15 2005;103(2):268-76. [Medline].

  29. Kim SJ, Park SE, Lee C, et al. Altered imprinting, promoter usage, and expression of insulin-like growth factor-II gene in gestational trophoblastic diseases. Gynecol Oncol. Mar 2003;88(3):411-8. [Medline].

  30. Olsen TG, Barnes AA, King JA. Elevated HCG outside of pregnancy--diagnostic considerations and laboratory evaluation. Obstet Gynecol Surv. Oct 2007;62(10):669-74; quiz 691. [Medline].

  31. Olsen TG, Hubert PR, Nycum LR. Falsely elevated human chorionic gonadotropin leading to unnecessary therapy. Obstet Gynecol. Nov 2001;98(5 Pt 1):843-5. [Medline].

  32. Khanlian SA, Cole LA. Management of gestational trophoblastic disease and other cases with low serum levels of human chorionic gonadotropin. J Reprod Med. Oct 2006;51(10):812-8. [Medline].

  33. Ngan HY, Chan FL, Au VW, et al. Clinical outcome of micrometastasis in the lung in stage IA persistent gestational trophoblastic disease. Gynecol Oncol. Aug 1998;70(2):192-4. [Medline].

  34. Gamer EI, Garrett A, Goldstein DP, et al. Significance of chest computed tomography findings in the evaluation and treatment of persistent gestational trophoblastic neoplasia. J Reprod Med. Jun 2004;49(6):411-4. [Medline].

  35. Kohorn EI. Negotiating a staging and risk factor scoring system for gestational trophoblastic neoplasia. A progress report. J Reprod Med. Jun 2002;47(6):445-50. [Medline].

  36. Hammond CB, Weed JC Jr, Currie JL. The role of operation in the current therapy of gestational trophoblastic disease. Am J Obstet Gynecol. Apr 1 1980;136(7):844-58. [Medline].

  37. Suzuka K, Matsui H, Iitsuka Y, et al. Adjuvant hysterectomy in low-risk gestational trophoblastic disease. Obstet Gynecol. Mar 2001;97(3):431-4. [Medline].

  38. Ngan HY, Odicino F, Maisonneuve P, et al. Gestational trophoblastic neoplasia. FIGO 6th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet. Nov 2006;95 Suppl 1:S193-203. [Medline].

  39. Kashimura Y, Kashimura M, Sugimori H, et al. Prophylactic chemotherapy for hydatidiform mole. Five to 15 years follow-up. Cancer. Aug 1 1986;58(3):624-9. [Medline].

  40. Massad LS, Abu-Rustum NR, Lee SS, et al. Poor compliance with postmolar surveillance and treatment protocols by indigent women. Obstet Gynecol. Dec 2000;96(6):940-4. [Medline].

  41. Soper JT, Clarke-Pearson DL, Berchuck A, et al. 5-day methotrexate for women with metastatic gestational trophoblastic disease. Gynecol Oncol. Jul 1994;54(1):76-9. [Medline].

  42. Foulmann K, Guastalla JP, Caminet N, et al. What is the best protocol of single-agent methotrexate chemotherapy in nonmetastatic or low-risk metastatic gestational trophoblastic tumors? A review of the evidence. Gynecol Oncol. Jul 2006;102(1):103-10. [Medline].

  43. Roberts JP, Lurain JR. Treatment of low-risk metastatic gestational trophoblastic tumors with single-agent chemotherapy. Am J Obstet Gynecol. Jun 1996;174(6):1917-23; discussion 1923-4. [Medline].

  44. Matsui H, Suzuka K, Yamazawa K, et al. Relapse rate of patients with low-risk gestational trophoblastic tumor initially treated with single-agent chemotherapy. Gynecol Oncol. Mar 2005;96(3):616-20. [Medline].

  45. Kohorn EI. Is lack of response to single-agent chemotherapy in gestational trophoblastic disease associated with dose scheduling or chemotherapy resistance?. Gynecol Oncol. Apr 2002;85(1):36-9. [Medline].

  46. Homesley HD, Blessing JA, Schlaerth J, et al. Rapid escalation of weekly intramuscular methotrexate for nonmetastatic gestational trophoblastic disease: a Gynecologic Oncology Group study. Gynecol Oncol. Dec 1990;39(3):305-8. [Medline].

  47. Osborne R, Filiaci V, Schink J, et al. A randomized phase III trial comparing weekly parenteral methotrexate and "pulsed" dactinomycin as primary management for low-risk gestational trophoblastic neoplasia: A Gynecologic Oncology Group study. Gynecol Oncol. 2008;108:S2-S3.

  48. Lurain JR. Advances in management of high-risk gestational trophoblastic tumors. J Reprod Med. Jun 2002;47(6):451-9. [Medline].

  49. Lurain JR, Singh DK, Schink JC. Primary treatment of metastatic high-risk gestational trophoblastic neoplasia with EMA-CO chemotherapy. J Reprod Med. Oct 2006;51(10):767-72. [Medline].

  50. Lehman E, Gershenson DM, Burke TW, et al. Salvage surgery for chemorefractory gestational trophoblastic disease. J Clin Oncol. Dec 1994;12(12):2737-42. [Medline].

  51. Escobar PF, Lurain JR, Singh DK, et al. Treatment of high-risk gestational trophoblastic neoplasia with etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine chemotherapy. Gynecol Oncol. Dec 2003;91(3):552-7. [Medline].

  52. Xiang Y, Sun Z, Wan X, et al. EMA/EP chemotherapy for chemorefractory gestational trophoblastic tumor. J Reprod Med. Jun 2004;49(6):443-6. [Medline].

  53. Yordan EL Jr, Schlaerth J, Gaddis O, et al. Radiation therapy in the management of gestational choriocarcinoma metastatic to the central nervous system. Obstet Gynecol. Apr 1987;69(4):627-30. [Medline].

  54. Cagayan MS, Lu-Lasala LR. Management of gestational trophoblastic neoplasia with metastasis to the central nervous system: A 12-year review at the Philippine General Hospital. J Reprod Med. Oct 2006;51(10):785-92. [Medline].

  55. Schechter NR, Mychalczak B, Jones W, et al. Prognosis of patients treated with whole-brain radiation therapy for metastatic gestational trophoblastic disease. Gynecol Oncol. Feb 1998;68(2):183-92. [Medline].

  56. Barnard DE, Woodward KT, Yancy SG, et al. Hepatic metastases of choriocarcinoma: a report of 15 patients. Gynecol Oncol. Sep 1986;25(1):73-83. [Medline].

  57. van Trommel NE, Massuger LF, Verheijen RH, et al. The curative effect of a second curettage in persistent trophoblastic disease: a retrospective cohort survey. Gynecol Oncol. Oct 2005;99(1):6-13. [Medline].

  58. Soper JT, Spillman M, Sampson JH, et al. High-risk gestational trophoblastic neoplasia with brain metastases: individualized multidisciplinary therapy in the management of four patients. Gynecol Oncol. Mar 2007;104(3):691-4. [Medline].

  59. Rojas-Espaillat L, Houck KL, Hernandez E, et al. Fertility-sparing surgery for persistent gestational trophoblastic neoplasia in the myometrium: a case report. J Reprod Med. May 2007;52(5):431-4. [Medline].

  60. Jones WB, Romain K, Erlandson RA, et al. Thoracotomy in the management of gestational choriocarcinoma. A clinicopathologic study. Cancer. Oct 1 1993;72(7):2175-81. [Medline].

  61. Carlson N, Winter WE 3rd, Krivak TC, et al. Successful management of metastatic placental site trophoblastic tumor with multiple pulmonary resections. Gynecol Oncol. Oct 2002;87(1):146-9. [Medline].

  62. Rustin GJ, Newlands ES, Lutz JM, et al. Combination but not single-agent methotrexate chemotherapy for gestational trophoblastic tumors increases the incidence of second tumors. J Clin Oncol. Oct 1996;14(10):2769-73. [Medline].

  63. Matsui H, Iitsuka Y, Suzuka K, et al. Risk of abnormal pregnancy completing chemotherapy for gestational trophoblastic tumor. Gynecol Oncol. Feb 2003;88(2):104-7. [Medline].

  64. Woolas RP, Bower M, Newlands ES, et al. Influence of chemotherapy for gestational trophoblastic disease on subsequent pregnancy outcome. Br J Obstet Gynaecol. Sep 1998;105(9):1032-5. [Medline].

  65. Lok CA, van der Houwen C, ten Kate-Booij MJ, et al. Pregnancy after EMA/CO for gestational trophoblastic disease: a report from The Netherlands. BJOG. Jun 2003;110(6):560-6. [Medline].

  66. Matsui H, Iitsuka Y, Suzuka K, et al. Salvage chemotherapy for high-risk gestational trophoblastic tumor. J Reprod Med. Jun 2004;49(6):438-42. [Medline].

  67. Knox S, Brooks SE, Wong-You-Cheong J, et al. Choriocarcinoma and epithelial trophoblastic tumor: successful treatment of relapse with hysterectomy and high-dose chemotherapy with peripheral stem cell support: a case report. Gynecol Oncol. Apr 2002;85(1):204-8. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

gestational trophoblastic disease, gestational trophoblastic tumors, GTD, GTN, hydatidiform mole, invasive mole, chorioadenoma destruens, choriocarcinoma, placental site trophoblastic tumor, PSTT, gestational trophoblastic neoplasia, molar pregnancy, uterine cancer, uterine tumor, cancer of the uterus

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Enrique Hernandez, MD, FACOG, FACS, Chairman, Department of Obstetrics and Gynecology, Director of Gynecologic Oncology, Abraham Roth Professor of Obstetrics, Gynecology and Reproductive Science, Professor of Pathology, Temple University Hospital, Temple University School of Medicine
Enrique Hernandez, MD, FACOG, FACS is a member of the following medical societies: Alpha Omega Alpha, American College of Obstetricians and Gynecologists, American College of Surgeons, American Medical Association, American Society for Colposcopy and Cervical Pathology, Association of Professors of Gynecology and Obstetrics, Johns Hopkins Medical and Surgical Association, Pennsylvania Medical Society, Philadelphia County Medical Society, and Society of Gynecologist Oncologists
Disclosure: Nothing to disclose.

Medical Editor

Robert C Shepard, MD, FACP, Associate Professor of Medicine in Hematology and Oncology at University of North Carolina at Chapel Hill; Vice President of Scientific Affairs, Therapeutic Expertise, Oncology, at PRA International
Robert C Shepard, MD, FACP is a member of the following medical societies: American Association for Cancer Research, American College of Physician Executives, American College of Physicians, American Federation for Clinical Research, American Federation for Medical Research, American Medical Association, American Medical Informatics Association, American Society of Hematology, Association of Clinical Research Professionals, Eastern Cooperative Oncology Group, European Society for Medical Oncology, Massachusetts Medical Society, and Society for Biological Therapy
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

Rajalaxmi McKenna, MD, FACP, Consulting Staff, Department of Medicine, Southwest Medical Consultants, SC, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

David Chelmow, MD, Professor of Obstetrics and Gynecology, Tufts University School of Medicine; Program Director, Tufts University Affiliated Hospitals Obstetrics/Gynecology Residency Program; Chair, Tufts University Health Sciences Campus Institutional Review Board; Vice Chair for Research and Education, Department of Obstetrics/Gynecology, Tufts Medical Center
David Chelmow, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, Phi Beta Kappa, Sigma Xi, Society for Gynecologic Investigation, and Society for Medical Decision Making
Disclosure: Nothing to disclose.

RELATED EMEDICINE ARTICLES
 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.