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LiFE re
Literature for ENYGO
Gestational trophoblastic disease
Editor Manuela Undurraga
Descriptive summary
Epidemiology and risk factors
Von Wessler et al. reviewed invasive moles in peri-menopausal
women. They found that the GTD in women older than 50 years is
rare, and that in these patients hysterectomy may be considered as
a first-line treatment.
Couder et al. retrospectively analysed risk factors for relapse in
patients with low-risk GTN treated with MTX alone. They found
that the antecedent pregnancy resulting in a delivery, and number
of methotrexate courses superior to 5, were independent predictive
factors of recurrence.
Gockley et al. analysed the impact of age on the incidence of molar
pregnancies. They found that the incidence of complete mole
differed significantly among maternal age groups, with adolescents
7.0 times as likely and women of advance maternal age twice as
likely to develop. The rate of PM did not vary significantly among
age groups.
The Dutch team lead by Eysbouts analysed the trend in incidence
of GTD over the last 20 years in their population. They found that
incidence rates have stabilised since 2004, with an overall incidence
rate of 1.67 per 1000 deliveries per year. They also found that partial mechanism than patients with hydatidiform mole. Patients with
and complete moles have reached similar incidences rates of 0.68
and 0.64 per 1,000 deliveries, respectively, from 2009 onwards,
with a decline of unspecified hydatidiform mole diagnosis to 0.03
per 1,000 deliveries. They conclude that this is all probably due to
improved diagnostic analyses and centralised pathological review.
Diagnosis
Lin et al. reviewed the use of Doppler ultrasound in the diagnosis of
GTD. They found that Doppler is not useful to distinguish between
partial and complete moles. For the prediction of development of
GTN, they note that most studies have observed a lower resistance
in the uterine artery (UA) is associated with the development of
GTN but data in the literature remain controversial and further
studies must be carried out. Doppler ultrasound seems to be a useful
adjuvant tool in post-molar follow-up and GTN diagnosis because
Doppler findings such as abnormal myometrial vascularization, lower
uterine artery (UA) Doppler indices, increased vascularization of the
myometrium, higher UA peak systolic velocity, and lower UA resist-
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International Journal of Gynecological Cancer, Volume 26, Supplement #1 Page 62
MISCELLANEOUS
ance index are correlated with invasive disease. Additional useful
information for follow-up includes an inverse correlation between
UA Doppler indices and hCG regression. Finally, they state that the
utilization of Doppler ultrasound may help predict chemotherapy
resistance; in particular, qualitative Doppler assessment might help
in managing patients with a plateaued hCG.
Mangili et al. reviewed the possible role of PET in the diagnosis and
follow up of GTD. They state that PET has a particularly useful role
in evaluating disease recurrence and chemo resistance, as well as
mapping possible sites of resectable disease. They conclude that
further studies are required to draw definitive conclusions on the
role of PET in diagnostic setting and the follow-up phase of GTD.
You et al. are in the process of validating a mathematical model
of hCG kinetics that may help predict MTX resistance, using the
GOG174 database. They state that the early predictive value of the
modelled kinetic parameter hCGres regarding resistance seems
promising, but that further prospective validation is warranted.
Follow-up and quality of life
One article investigated the psychological impact during illness and
follow-up in patients with GTD. They found that patients with ges-
tational trophoblastic neoplasia (GTN) have a more mature defence
less mature defence mechanism had a higher state of anxiety and a
higher degree of infertility-related global stress.
Treatment
Faaborg et al. analysed their success rate with oral methotrexate
(MTX). In a retrospective study that covered 30 years, they found
that 49 % of patients (90 % of whom were classified as FIGO
low-risk disease) had a complete response after-first line therapy
with oral MTX, while 87 % had complete remission after oral MTX
(first-line) and/or MTX plus dactinomycin (second-line). Patients who
did not respond to oral MTX usually had higher hCG levels, larger
tumour sizes, and higher FIGO scores.
In another retrospective study, Kizaki et al. compared the primary
remission rates and predictors of drug resistance in patients with
low-risk GTN treated with two different treatment regimens. They