Abstract
Gestational trophoblastic neoplasia (GTN) is highly chemosensitive and has a high cure rate. Since the introduction of chemotherapy, reliable measurement of human chorionic gonadotropin (hCG) levels, and individualised risk-based therapy into the management of GTN, almost all low-risk and more than 80 % of high-risk GTN cases are curable. However, approximately 25 % of high-risk GTN developed resistance to chemotherapy or relapsed after completion of initial therapy, which often necessitate salvage combination chemotherapy. On the other end of the spectrum, a proportion of patients with gestational trophoblastic disease (GTD) have persistently low levels of hCG, without clinical or radiological evidence of disease, a condition called quiescent GTD. Recently, measurement of hyperglycosylated hCG has been proposed for the management of patients with quiescent GTD. Although representing a small proportion of GTD cases, the management of patients with chemoresistant and quiescent GTD often poses challenges to medical practitioners.
Highlights
Gestational trophoblastic neoplasia (GTN) is highly chemosensitive and has a high cure rate
Risk factors that predispose a patient to drug resistance and relapse include number of consolidation courses administered, clinicopathologic diagnosis of choriocarcinoma, initial human chorionic gonadotropin (hCG) level, extent of disease, and higher World Health Organization (WHO) risk scores [5, 6]
Chemotherapy was ineffective because the tissue in quiescent gestational trophoblastic disease (GTD) is not growing, and in most cases hCG returned to normal within 6 months
Summary
Gestational trophoblastic neoplasia (GTN) is highly chemosensitive and has a high cure rate. Risk factors that predispose a patient to drug resistance and relapse include number of consolidation courses administered, clinicopathologic diagnosis of choriocarcinoma, initial hCG level, extent of disease (brain, liver, and gastrointestinal metastases have a worse prognosis), and higher World Health Organization (WHO) risk scores [5, 6]. Most of these patients are salvageable by further chemotherapy; 20 % of patients will eventually become resistant to treatment and die. Our centre reported use of MBE in 16 patients who developed drug resistance to combination chemotherapy or relapsed after combination therapies, with a response rate of 88 % and 5-year disease free survival of 63 % [12]. The Sheffield Trophoblastic Disease Center, UK, reported that 9 (75 %) of 12 patients who underwent hysterectomy for chemoresistant uterine disease had a complete clinical response to surgery [22]
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