Centralization of the management of gestational trophoblastic disease in Europe: from local centers to European Reference Networks

200th ENMC International Workshop “European Reference Networks: Recommendations and Criteria in the Neuromuscular field”, 18–20 October 2013, Naarden, the Netherlands

Guideline No. 408: Management of Gestational Trophoblastic Diseases

Gestational trophoblastic disease II: classification and management of gestational trophoblastic neoplasia

This article reviews the different disease entities that fall under the classification of gestational trophoblastic disease (GTD). The conditions included range from molar pregnancy to the malignant forms of gestational trophoblastic neoplasm (GTN). These disorders all arise from abnormal placental trophoblastic development. The different types of GTD, symptomatology, and diagnostic modalities are examined. The various methods of treatment are reviewed. Although the management of GTD and GTN falls outside the scope of midwifery practice, midwives need to be aware of the incidence, risk factors, and symptoms for specific types of GTD in order to be able to diagnose and refer for treatment in a timely manner. Psychosocial aspects that affect the woman who has not only had a pregnancy loss but also may be faced with a life-threatening illness are examined. The role of the midwife in the management, counseling, and follow-up of GTD and GTN is discussed.

How to optimize the management of gestational trophoblastic disease during the coronavirus disease era?

Circulating Tumor DNA: A Potential Novel Diagnostic Approach in Gestational Trophoblastic Neoplasia

Practical management of gestational trophoblastic disease

Although sensitive human chorionic gonadotrophin (hCG) assays and advances in chemotherapy have assumed primary importance in the management of gestational trophoblastic disease (GTD), surgery and radiation therapy remain important in the overall management of patients. Management of molar pregnancies consists of surgical evacuation and subsequent monitoring. Hysterectomy may decrease the risk of post-molar trophoblastic disease. When incorporated into the primary management of malignant GTD, hysterectomy decreases chemotherapy requirements for patients with low-risk disease. Surgical intervention is frequently required to control complications of disease or as therapy to stabilize patients during chemotherapy. Salvage hysterectomy or other extirpative procedures may be integrated into the management of patients with chemorefractory disease. Interventional radiographical techniques are useful adjuncts to control haemorrhage from vaginal or pelvic metastases. Radiation therapy may also be combined with chemotherapy for the management of patients with brain metastases or, rarely, isolated metastases at other sites.

Role of surgery and radiation therapy in the management of gestational trophoblastic disease

Background: Gestational trophoblastic disease (GTD) is a rare pregnancy-related condition consisting of premalignant and malignant forms arising from proliferation of trophoblastic cells. The malignant forms are collectively referred to as gestational trophoblastic neoplasia (GTN) and are highly sensitive to chemotherapy. However, surgical procedures remain indispensable in the diagnosis and treatment of GTD. Objectives: The aim of this review was to summarize surgical interventions in the treatment of GTD and GTN. We reviewed indications, efficacy, possible complications, and oncological outcomes of surgery. Methods: Three searches were performed in the databases of PubMed, Embase, and the Cochrane Library to create an up-to-date overview of existing literature on the following subjects: (1) the role of primary hysterectomy in GTD and GTN; (2) the role of second curettage in GTD and GTN; (3) fertility sparing surgery in GTN; (4) surgical management of metastases. Included articles originated from the time period 1952–2022. Articles written in English, Spanish, and French were included. Outcomes: Thirty-eight articles were found and selected. Surgical evacuation through suction curettage is most used and advised in the treatment of GTD. A second curettage could be beneficial in patients with low hCG levels and low FIGO scores. In women who have completed their families, primary hysterectomy might be considered as the risk of subsequent GTN is lower than after suction curettage. In case of the rare forms of GTN (epithelioid trophoblastic tumor or placental site trophoblastic tumor) surgical tumor resection remains the most important step in treatment. Data on fertility sparing surgery in GTN are scarce and this treatment should be considered experimental. Conclusion and Outlook: Surgery remains an important part of treatment of GTD and is sometimes indispensable to achieve curation. Further collection of evidence is needed to determine treatment steps.

Background/objectives: Gestational trophoblastic diseases (GTDs) are rare premalignant and malignant conditions characterized by abnormal proliferation of trophoblastic tissue. They are often asymptomatic but may present with vaginal bleeding. GTDs include hydatidiform moles and gestational trophoblastic neoplasms (GTNs). Current research aims to improve diagnostic tools and treatment strategies to reduce cancer risk and improve survival. Increasing attention is being paid to immunotherapy and treatment personalization, with the goal of minimizing long-term side effects and enhancing quality of life. Less toxic therapies are ideal for low-risk patients to reduce drug-related toxicity. Materials and Methods: A narrative review was conducted to analyze studies from the last twenty years on the diagnosis, staging, and treatment of GTDs. Sources included PubMed, Scopus, and Cochrane Library, using keywords such as “trophoblastic disease,” “hydatidiform mole,” and “gestational trophoblastic neoplasia.” Results: In recent years, the clinical management of gestational trophoblastic disease (GTD) has made significant progress through diagnostic, prognostic, and therapeutic innovations. More sensitive imaging techniques and serial monitoring of serum β-hCG now allow early diagnosis of hydatidiform mole and gestational trophoblastic neoplasia (GTN), reducing the risk of complications and metastasis. Conclusions: In the last decade, GTD management has improved significantly, with better diagnostic techniques, standardized staging, and more effective treatments. However, challenges persist, including relapse management, long-term monitoring, and psychological support. Early diagnosis is key, with ultrasound being essential for detecting abnormalities in the first weeks of pregnancy. Staging follows FIGO and WHO criteria, considering hCG levels and metastasis. This review highlights recent advances in diagnostic tools, emerging therapies—including immunotherapy—and the need for personalized, less toxic treatment approaches to improve patient outcomes.

A novel alternative to cytotoxic chemotherapy for gestational trophoblastic disease.

Current management of gestational trophoblastic diseases

Clinical management of trophoblastic disease in the United Kingdom

The quagmire of hCG and hCG testing in gynecologic oncology