Gestational trophoblastic disease

Abstract

Gestational trophoblastic disease belongs to a spectrum of rare tumors originating from trophoblast. It spreads from the benignant disease uncomplicated partial mole to the most malignant choriocarcinoma in stage IV of disease with brain metastases. Fortunately, with adequate chemotherapy even patients in advanced stage of the disease have significant chances to be cured. In estimating prognosis and adequate therapy of disease, the most significant are clinical factors: serum hCG level, duration of the disease from termination of antecedent pregnancy, prior chemotherapy, brain or liver metastases. hCG is an ideal tumor marker for follow up and early diagnosis of recidivism and metastases. In the Institute of Oncology in Sremska Kamenica 32 patients with gestational trophoblastic disease were treated in the period from 1987 to 2001. All the patients with non-metastatic disease and low risk metastatic disease (stage I-III FIGO) were successfully cured. Five patients died, all in stage IV of the disease (FIGO) with liver and brain metastases; in 4 of them disease occurred after term pregnancy. Overall survival was 85%. Treatment of non-metastatic and low risk metastatic disease was successful in all cases. Treatment failures occurred in advanced disease with brain and liver metastasis Specificity and low incidence of this disease ask for the treatment to be carried out in specialized centers, as it is in developed countries (Trophoblastic Disease Centers).

Keywords

• trophoblastic neoplasms
• choriocarcinoma
• risk factors
• antineoplastic combined chemotherapy protocols
• treatment outcome