Radioimmunoassay of free ß-subunit of human chorionic gonadotropin in diagnosis of high-risk and low-risk gestational trophoblastic disease

1989 ◽  
Vol 160 (2) ◽  
pp. 444-449 ◽  
Author(s):  
M.B. Khazaeli ◽  
E.S. Buchina ◽  
R.A. Pattillo ◽  
S.-J. Soong ◽  
K.D. Hatch
Keyword(s):  
High Risk ◽  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Gestational Trophoblastic Disease ◽  
Low Risk ◽  
Trophoblastic Disease

Is there uniformity in definitions and treatment of gestational trophoblastic disease in Europe?

2019 ◽  
Vol 29 (1) ◽  
pp. 108-112 ◽  
Author(s):  
Minke M Frijstein ◽  
Christianne A R Lok ◽  
John Coulter ◽  
Nienke E van Trommel ◽  
Marianne J ten Kate – Booij ◽  
...  
Keyword(s):  
High Risk ◽  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Gestational Trophoblastic Disease ◽  
Gestational Trophoblastic Neoplasia ◽  
Clinical Practices ◽  
Trophoblastic Disease ◽  
Consensus Statements ◽  
Definition Of

ObjectivesBecause gestational trophoblastic disease is rare, little evidence is available from randomized controlled trials on optimal treatment and follow-up. Treatment protocols vary within Europe, and even between different centers within countries. One of the goals of the European Organization for Treatment of Trophoblastic Diseases (EOTTD) is to harmonize treatment in Europe. To provide a basis for international standardization of definitions, treatment and follow-up protocols in gestational trophoblastic disease, we evaluated differences and similarities between protocols in EOTTD countries.MethodsMembers from each EOTTD country were asked to complete an online structured questionnaire comprising multiple-choice and multiple-answer questions. The following themes were discussed: incidence of gestational trophoblastic disease and gestational trophoblastic neoplasia, definitions, guidelines, classification system, treatment, recurrence, and follow-up.ResultsForty-four respondents from 17 countries participated in this study. Guidelines were present in 80% of the countries and the FIGO (Fédération Internationale de Gynécologie et d'Obstétrique) staging and risk classification was often used to estimate risks. Agreement about when to start chemotherapy for post-molar gestational trophoblastic neoplasia was present among 66% of the respondents. Preferred first-line treatments in low- and high-risk gestational trophoblastic neoplasia were methotrexate (81%) and EMA-CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) (93%), respectively. The definition of human chorionic gonadotropin normalization after hydatidiform mole evacuation was two consecutive normal values for nine countries. The FIGO definition of post-molar gestational trophoblastic neoplasia based on human chorionic gonadotropin plateau or rise was agreed on by 69% of respondents, and only 69% and 74% defined low-risk and high-risk disease, respectively, using FIGO criteria. There were major differences in definitions of recurrence, chemotherapy resistance and follow-up protocols among countries, despite EOTTD consensus statements.ConclusionsThis questionnaire provides a good overview of current clinical practices in different countries. Based on the survey results, it is clear that there are several gestationaltrophoblastic disease-related topics that need urgent attention within the EOTTD community to create more uniformity and to aid the development of uniform guidelines in Europe.

Gestational trophoblastic disease: Experience at a tertiary care center from a developing country

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 16041-16041
Author(s):  
R. Hariprasad ◽  
K. Ganessan ◽  
A. Gupta ◽  
L. Kumar ◽  
S. Kumar ◽  
...  
Keyword(s):  
High Risk ◽  
Actinomycin D ◽  
Care Center ◽  
Tertiary Care ◽  
Risk Groups ◽  
Gestational Trophoblastic Disease ◽  
Low Risk ◽  
Molar Pregnancy ◽  
Excellent Outcome ◽  
Trophoblastic Disease

16041 Background: We retrospectively analyzed case records of patients diagnosed to have Gestational Trophoblastic Disease (GTD) to determine clinical characteristics, risk groups, treatment outcome, and reproductive function post treatment. Methods: Between Jan 1991 to Dec 2005, 102 patients (mean age: 28.2 years, range 19–50) were diagnosed to have GTD. 35 patients were nulliparous and 8 had prior molar pregnancy. Vaginal bleeding was the most common presenting symptom (77.5%). The antecedent pregnancy was vesicular mole in 50%, abortion - 34.3%, ectopic pregnancy - 4% and term pregnancy in 11.8% patients. The mean value of B hCG was 1225386 mIU/ml. The histopathology (n=85) was complete mole in 30, partial mole - 28, invasive mole- 9, PSTT -1 and choriocarcinoma in 17 patients. 68(66.7%) patients had non-metastatic disease. Sites of metastasis were - lung (38.2%), vagina (11%), brain (8.8%), liver (6.9%) and kidney, Urinary bladder and peritoneum in one patient each. According to modified WHO risk scoring - 78(76.5% had low risk and 24 (23.5%) were high risk. Results: Eighty-seven (85.3%) patients received chemotherapy using methotrexate with leucovorin (n=63), EMA/CO (n=19) and BEP (n=5). 77/87 (89.5%) achieved complete remission (CR) ; the response rate was higher in non-metastatic GTD (p<0.05). Two of 7(28.6%) patients with liver and 5/9 (55,6%) of brain metastasis achieved CR. Two patients had grade III oral mucositis and diarrhoea with methotrexate. One patient died of Methotrexate hypersensitivity. 19 patients received second line chemotherapy using EMA/CO (n=11), EMA/EP (n=2), BEP (n=1), actinomycin-D (n=1) and MAC (methotrexate, actinomycin D and Cyclophosphamide) n=1; 14 patients achieved CR. At a mean follow up of 180 months, 5-year survival for patients with low risk is 100% and that of high risk is 95%. Eight patients had recurrent disease including recurrent molar pregnancy in four. 16 patients had 24 successful deliveries after completion of treatment and 10 of them were primiparae. No fetal abnormalities were found. We did not observe second malignancy or other therapy related sequele. Conclusions: Present study confirms excellent outcome for patients with gestational trophoblastic disease. The potential for childbearing is well maintained. No significant financial relationships to disclose.

Gestational trophoblastic disease: 25-year experience at the Instituto Nacional de Enfermedades Neoplasicas (INEN)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 16031-16031
Author(s):  
L. Mas Lopez ◽  
M. Olivera ◽  
L. Casanova ◽  
C. Santos ◽  
S. Neciosup ◽  
...  
Keyword(s):  
Overall Survival ◽  
Survival Rate ◽  
High Risk ◽  
Complete Remission ◽  
Risk Score ◽  
Gestational Trophoblastic Disease ◽  
Low Risk ◽  
Overall Survival Rate ◽  
Trophoblastic Disease ◽  
Results Of Treatment

16031 Background: To evaluate the clinical behavior and results of treatment of gestational trophoblastic disease at INEN between 1980 to 2005. Methods: This is a retrospective analysis of patients with gestational trophoblastic disease, clinical characteristics, results of treatment, toxicity, objective response and survival from January 1980 to December 2005. Descriptive statistics and Kaplan-Meier for survival analysis were performed. Results: Since Jan 1980 to Dec 2005. 595 patients were admitted at INEN; Hydatidiform mole 254 (42.7%) choriocarcinoma 201 (33.8%) invasive mole 41(6.8%). FIGO scoring System, high risk (score >6): 247 (41.5%), low risk (score 1–6): 348 (58.5%). Age ranged from 14 to 54 years, with 255 (44%) cases between 20 to 29 years. The sities of metastasis: lung 67.3%, vaginal 17.9%, brain 8.7%, liver 5.1%. The patients with low risks received treatment with Metotrexate 0.4mg/kg x day x 5 days po, reach disease control with a mean course of 6 (1 - 14), complete remission in 66.1% cases and 97% the overall survival rate to 20 years. Patients with high risk received treatment with: MAC 77 patients, MEC 19 patients, EMACO 48 patients and BEP 14 patients and achieved complete remission in 32.5%, 36.8%, 50% and 25% respectively. On the high risk group we detected two groups according to score > 12 and < 12, with diferent probability of survival at 20 years, for the group with score <12, 80% and the group with score >12, 48%. 98 patients were identified with score >12, and the age of these patients ranged from 15 to 51 years, with a mean age of 36.5 years. The blood B- HCG titers of these patients ranged from 198 to 6710,500. Liver and brain metastasis in 26 cases, number metastasis mayor 8 in 78 cases. Conclusions: Gestational trofhoblastic disease is highly curable. Patients of low risk achieved a 97% overall survival rate to 20 years. There are differences in the overall survival rate between patients of high risk with a score < 12 (80%) and score >12 (48%). This group presented with brain and liver metastasis, and it is important to define the best treatment for this group of patients No significant financial relationships to disclose.

False-positive β-human chorionic gonadotropin values in the follow-up of gestational trophoblastic disease

2007 ◽  
Vol 9 (5) ◽  
pp. 332-334
Author(s):  
V. M. Díaz Muñoz de la Espada ◽  
J. A. Arranz Arija ◽  
P. Khosravi Shahi ◽  
S. Encinas García ◽  
R. Álvarez Álvarez ◽  
...  
Keyword(s):  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
False Positive ◽  
Gestational Trophoblastic Disease ◽  
Trophoblastic Disease

Low-Risk Persistent Gestational Trophoblastic Disease: Outcome After Initial Treatment With Low-Dose Methotrexate and Folinic Acid From 1992 to 2000

2002 ◽  
Vol 20 (7) ◽  
pp. 1838-1844 ◽  
Author(s):  
I. A. McNeish ◽  
S. Strickland ◽  
L. Holden ◽  
G. J.S. Rustin ◽  
M. Foskett ◽  
...  
Keyword(s):  
High Risk ◽  
Folinic Acid ◽  
Single Agent ◽  
Gestational Trophoblastic Disease ◽  
Low Risk ◽  
Trophoblastic Disease ◽  
Number Of Patients ◽  
Second Tumors ◽  
Third Line ◽  
Chemotherapy Patients

PURPOSE: We have simplified the treatment of gestational trophoblastic disease (GTD) in order to reduce the number of patients exposed to potentially carcinogenic chemotherapy. Patients who score 0 to 8 on the Charing Cross scoring system are classified as low-risk and receive methotrexate (MTX) and folinic acid (FA), whereas those who score higher than 8 are classified as high-risk and receive the etoposide, methotrexate, and dactinomycin (EMA)/cyclophosphamide and vincristine (CO) regimen. PATIENTS AND METHODS: Between 1992 and 2000, 485 women with GTD were commenced on MTX/FA at Charing Cross Hospital, London, United Kingdom. If patients developed MTX resistance or toxicity, treatment was altered according to the level of beta human chorionic gonadotropin (hCG). If serum hCG was ≤ 100 IU/L, patients received dactinomycin; if hCG was greater than 100 IU/L, patients received EMA/CO. RESULTS: The median duration of follow-up was 4.7 years. Overall survival was 100% and the relapse rate was 3.3% (16 of 485 patients). hCG values normalized in 324 (66.8%) of 485 patients with MTX alone, whereas 161 (33.2%) of 485 patients required a change in treatment, 11 because of MTX toxicity and 150 because of MTX resistance. Sixty-seven patients changed to dactinomycin, of whom 58 achieved normal hCG values, and nine required third-line chemotherapy with EMA/CO. hCG values normalized in 93 (98.9%) of 94 patients who changed directly to EMA/CO from MTX. CONCLUSION: Single-agent dactinomycin has activity in patients with low-risk GTD who develop MTX resistance and whose hCG is low. Simplifying the stratification of GTD into two classes (low- and high-risk) does not compromise overall outcome and may reduce the risk of second tumors.

Conservative Chemotherapy in Gestational Trophoblastic Disease: Experience With Etoposide, Methotrexate, and Dactinomycin Chemotherapy

2016 ◽  
Vol 26 (4) ◽  
pp. 790-795 ◽  
Author(s):  
Seung Won Byun ◽  
Tae Chul Park ◽  
Seog Nyeon Bae
Keyword(s):  
High Risk ◽  
Gestational Trophoblastic Disease ◽  
Low Risk ◽  
The Other ◽  
World Health ◽  
Who Grade ◽  
Trophoblastic Disease ◽  
Group A ◽  
Group B ◽  
Health Organization

ObjectiveThe goal of this study was to evaluate the efficacy, toxicity, and survival of patients in our institution treated by EMA (etoposide, methotrexate [MTX], and dactinomycin) chemotherapy for 3 groups of patients: ones that had low-risk gestational trophoblastic disease (GTD) that was resistant to MTX (group A), those with high-risk GTD (group B), and the group having low-risk GTD but the cancer being metastatic (group C).MethodsThe medical records of 58 patients who received EMA chemotherapy in groups A, B, and C in the 2000 to 2012 period at St Mary’s Hospital were examined. Clinical characteristics, chemotherapy responses, causes of treatment failure, and cases of drug toxicity were analyzed retrospectively.ResultsTreatment with the EMA regimen resulted in primary remission in 52 (96%) of 54 patients and resistance in 2 of the patients (3%). In the resistance group, one belonged to group B and was treated with etoposide, MTX, and actinomycin D with cyclophosphamide and vincristine (EMA-EP) and the other belonged to group A and died of refractory disease. World Health Organization (WHO) grade 4 leukocytopenia and thrombocytopenia with the EMA regimen occurred in 6% and 0.4% of the cycles, respectively; the other toxic effects were acceptable and manageable. Median cycles of EMA chemotherapy during the treatment were 7, 8, and 8 in groups A, B, and C, respectively. There was some reduction in total chemo cycle and toxicity, as compared with a previously reported study using the alternative cyclophosphamide and vincristine regimen. Among the EMA treated patients, 1 patient with a second malignancy of breast cancer was documented. In addition, 5 child births for the treated patients were recorded during the follow-up period of mostly 10 years.ConclusionsThe EMA chemotherapy seemed to reduce treatment duration and the relapse rate without increasing the adverse effects in patients with MTX resistance and low-risk GTD, but having confirmed metastatic lesions. Although this study had some limitations regarding the high-risk GTD, our findings will provide a basis for the use of EMA chemotherapy when cyclophosphamide and vincristine is contraindicated due to toxicity.

scholarly journals Perimenopausal giant hydatidiform mole complicated with preeclampsia and hyperthyroidism: A case report and literature review

Open Medicine ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. 1038-1042
Author(s):  
Yan Wan ◽  
Guoqing Jiang ◽  
Ying Jin ◽  
Zengping Hao
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Optimal Treatment ◽  
Perimenopausal Woman ◽  
Trophoblastic Disease ◽  
Reproductive Females

Abstract Gestational trophoblastic disease (GTD) commonly occurs in reproductive females, but is extremely rare in perimenopausal females. In this study, we reported a case of hydatidiform mole in a 48-year-old perimenopausal female admitted due to a giant uterine mass of 28 weeks’ gestational size. The serum human chorionic gonadotropin (HCG) level ranged from 944 to 1,286 mIU/mL before treatments. The signs of preeclampsia and hyperthyroidism were relatively prominent. Hysterectomy was performed and chemotherapy was scheduled when the serum HCG level remained at a plateau, about 528 mIU/mL. The symptoms of preeclampsia and hyperthyroidism were relieved after treatment. Accordingly, we concluded that GTD could occur in perimenopausal woman and hysterectomy usually is the optimal treatment.

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