Management Options of Gestational Trophoblastic Disease

• Published in: Current obstetrics and gynecology reports 2014-03, Vol.3 (1), p.76-83
• Main Authors: Berkowitz, Ross S., Goldstein, Donald P., Horowitz, Neil S.
• Format: Article
• Language: English
• Subjects: Management of Gestational Trophoblastic Diseases (A Cheung; Maternal and Child Health; Medicine; Medicine & Public Health; Obstetrics/Perinatology/Midwifery; Oncology; Section Editor
• ISSN: 2161-3303; 2161-3303
• DOI: 10.1007/s13669-013-0065-4

During the past year, studies have advanced the understanding and management of gestational trophoblastic diseases. Molar pregnancy is now diagnosed earlier in gestation across the globe due to increasingly availability of hCG measurement and pelvic ultrasound. Earlier diagnosis reduces the presence of classic signs and symptoms but does not affect the frequency of postmolar gestational trophoblastic neoplasia (GTN). Molar pregnancy is known to be more common at the extremes of reproductive age, and studies have advanced our understanding of the natural history of molar pregnancy in adolescents and women in their 40s. Studies also have improved administration of chemotherapy. A prospective, randomized trial showed that pulse actinomycin D induced higher complete remission rates than weekly methotrexate in low-risk GTN. Investigations also have indicated the proper amount of consolidation chemotherapy in low-risk GTN and the value of low-dose induction chemotherapy in patients with a high disease burden. However, important work remains to be done.