Continued hCG surveillance following chemotherapy for gestational trophoblastic neoplasia: When is enough enough?

Abstract

Gestational trophoblastic neoplasia (GTN) has the highest rate of long-term cure among all gynecologic malignancies. Overall survival rates stratified by International Federation of Gynecology and Obstetrics (FIGO) prognostic risk score approach 100% for low-risk disease (score <7) and exceed 90% even for high-risk disease (scores ≥7) [ 1 Alifrangis C Agarwal R Short D et al. EMA/CO for high-risk gestational trophoblastic neoplasia: good outcomes with induction low-dose etoposide-cisplatin and genetic analysis. J Clin Oncol. 2013; 31: 280-286 Crossref PubMed Scopus (115) Google Scholar ]. This stems from high rates of primary remission with chemotherapy as well as very high salvage rates from second- and third-line regimens. Remission in GTN is defined by human chorionic gonadotropin (hCG) levels falling below the lower limit of detection of the employed reference assay. Currently, the National Comprehensive Cancer Network (NCCN) recommends post-treatment surveillance for GTN with one year of monthly serum hCG monitoring [ 2 Network NCC. Gestational trophoblastic neoplasia[Accessed August 9, 2018: Available from:http://www,nccn.org.professionals/physicians_gls/pdf/gtn.pdf Google Scholar ]. However, relapses can occur beyond the one-year mark, raising the question of whether longer term surveillance is warranted. When to stop human chorionic gonadotrophin (hCG) surveillance after treatment with chemotherapy for gestational trophoblastic neoplasia (GTN): A national analysis on over 4,000 patientsGynecologic OncologyVol. 155Issue 1PreviewTo determine the optimal duration of human chorionic gonadotrophin (hCG) surveillance following treatment for low and high risk gestational trophoblastic neoplasia (GTN) and establish whether the current surveillance protocol that recommends life-long hCG monitoring requires revision. Full-Text PDF