Treatment modalities and clinical outcomes in patients with gestational trophoblastic disease
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20250170Keywords:
Clinical outcomes, Choriocarcinoma, Gestational trophoblastic disease, Molar pregnancyAbstract
Background: Gestational trophoblastic disease (GTD) encompasses a diverse group of disorders characterized by abnormal trophoblastic tissue proliferation, including premalignant conditions like hydatidiform moles and malignant types such as choriocarcinoma and persistent trophoblastic disease, which carry significant malignant potential. The purpose of this study was to evaluate the effectiveness of various treatment modalities and the clinical outcomes in patients diagnosed with gestational trophoblastic disease. The aim of the study was to evaluate the effectiveness of various treatment modalities and the clinical outcomes in patients diagnosed with gestational trophoblastic disease.
Methods: This descriptive cross-sectional study, conducted at the Department of Obstetrics and Gynaecology, Sir Salimullah Medical College and Mitford Hospital, Dhaka (November 2012 - November 2013), included 50 cases of gestational trophoblastic disease (GTD). Inclusion criteria were fresh, incompletely treated, and recurrent GTD cases. Data were collected via a pretested questionnaire, analyzed using SPSS, and presented as descriptive statistics. Ethical approval and informed consent were obtained from all participants.
Results: Among 50 GTD cases, 60% were complete moles, with 94.44% of persistent disease linked to prior molar pregnancies. P/V bleeding was the most common symptom. Choriocarcinoma showed 50% metastasis, mainly to lungs, and 86% remission with EMACO therapy. Suction evacuation treated 56% of molar pregnancies, with 13.5% progressing to persistent mole and 4.5% to choriocarcinoma.
Conclusions: This study highlights the importance of early detection, timely treatment, and regular follow-up in improving outcomes for patients with gestational trophoblastic disease.
Metrics
References
Joneborg U, Folkvaljon Y, Papadogiannakis N, Lambe M, Marions L. Temporal trends in incidence and outcome of hydatidiform mole: a retrospective cohort study. Acta Oncolog. 2018;57(8):1094-9. DOI: https://doi.org/10.1080/0284186X.2018.1438653
Eysbouts YK, Bulten J, Ottevanger PB, Thomas CM, Ten Kate-Booij MJ, Van Herwaarden AE, Siebers AG, Sweep FC, Massuger LF. Trends in incidence for gestational trophoblastic disease over the last 20 years in a population-based study. Gynecol Oncolo. 2016;140(1):70-5. DOI: https://doi.org/10.1016/j.ygyno.2015.11.014
Savage P, Williams J, Wong SL, Short D, Casalboni S, Catalano K, Seckl M. The demographics of molar pregnancies in England and Wales from 2000-2009. J Reprod Med. 2010;55(7-8):341-5.
Seckl MJ, Sebire NJ, Berkowitz RS. Gestational trophoblastic disease. Lancet. 2010;376(9742):717-29. DOI: https://doi.org/10.1016/S0140-6736(10)60280-2
Palmer JR. Advances in the epidemiology of gestational trophoblastic disease. J Reproduct Medi. 1994;39(3):155-62.
Ilancheran A. Optimal treatment in gestational trophoblastic disease. Annals-Acad Medi Sing. 1998;27:698-704.
Czernobilsk B, Barash A, Lancet M. Partial moles: a clinicopathologic study of 25 cases. Obstetr Gynecol. 1982;59(1):75-7.
Berkowitz RS, Goldstein DP, Bernstein MR. Natural history of partial molar pregnancy. Obstetr Gynecol. 1985;66(5):677-81.
Seckl MJ, Sebire NJ, Fisher RA, Golfier F, Massuger L, Sessa C. Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24:vi39-50. DOI: https://doi.org/10.1093/annonc/mdt345
Tidy J, Hancock BW, Osborne R, Lawrie TA. First‐line chemotherapy in low‐risk gestational trophoblastic neoplasia. Cochrane Database of Systematic Reviews. 2012;7.
Berkowitz RS, Goldstein DP. Current management of gestational trophoblastic diseases. Gynecol Oncol. 2009;112(3):654-62. DOI: https://doi.org/10.1016/j.ygyno.2008.09.005
McNeish IA, Strickland S, Holden L, Rustin GJ, Foskett M, Seckl MJ, et al. Low-risk persistent gestational trophoblastic disease: outcome after initial treatment with low-dose methotrexate and folinic acid from 1992 to 2000. J Clin Oncol. 2002;20(7):1838-44. DOI: https://doi.org/10.1200/JCO.2002.07.166
Lurain JR, Chapman-Davis E, Hoekstra AV, Schink JC. Actinomycin D for methotrexate-failed low-risk gestational trophoblastic neoplasia. J Reproduct Medi. 2012;57(7-8):283-7.
Sita-Lumsden A, Short D, Lindsay I, Sebire NJ, Adjogatse D, Seckl MJ, et al. Treatment outcomes for 618 women with gestational trophoblastic tumours following a molar pregnancy at the Charing Cross Hospital, 2000–2009. Brit J Cancer. 2012;107(11):1810-4. DOI: https://doi.org/10.1038/bjc.2012.462
Lok C, van Trommel N, Massuger L, Golfier F, Seckl M, Abreu MH, et al. Practical clinical guidelines of the EOTTD for treatment and referral of gestational trophoblastic disease. Euro J Cancer. 2020;130:228-40. DOI: https://doi.org/10.1016/j.ejca.2020.02.011
Al Riyami N, Al Riyami M, Al Saidi S, Salman B, Al Kalbani M. Gestational trophoblastic disease at Sultan Qaboos University Hospital: Prevalence, risk factors, histological features, sonographic findings, and outcomes. Oman Medi J. 2019;34(3):200. DOI: https://doi.org/10.5001/omj.2019.39
Mdoe MB, Mwakigonja AR, Mwampagatwa I. Gestational trophoblastic disease and associated factors among women experiencing first trimester pregnancy loss at a regional referral hospital in central Tanzania: a cross-sectional study. International Health. 2023;15(3):250-7. DOI: https://doi.org/10.1093/inthealth/ihac015
Shahzadi M, Khan SR, Tariq M, Baloch SS, Shahid A, Moosajee M, Samon Z. Review of current literature on gestational trophoblastic neoplasia. J Egypt National Cancer Institute. 2023;35(1):37. DOI: https://doi.org/10.1186/s43046-023-00195-y
Ngan HY, Seckl MJ, Berkowitz RS, Xiang Y, Golfier F, Sekharan PK, et al. Diagnosis and management of gestational trophoblastic disease: 2021 update. Inter J Gynecol Obstetr. 2021;155:86-93. DOI: https://doi.org/10.1002/ijgo.13877