Treatment Of Gestational Trophoblastic Disease

1. In many cases a hydatiform mole may spontaneously dissolve on its own and be expelled. In this case the physician will follow the beta-hCG for awhile to ensure that all of the trophoblastic tissue was expelled and there is no recurrence. The woman also is usually treated with 6 months of contraceptive medication.

2. If a mole comes back or it does not dissolve spontaneously, the doctor has to remove it with suction curettage, where all of the hydatidiform tissue is removed from the uterine cavity. This is carefully monitored with beta-HCG levels later to ensure that the last tissue bits have been removed. It takes about 10-12 weeks for the blood titre to clear even when all the tissue has been removed. The direction of the elimination curve, when the titers are plotted as a graph, will tell the physician whether or not all the tissue has been removed or not. About 80% of patients do not need any further therapy than this.

3. High risk molar pregnancy is being treated with combination chemotherapy consisting of methotrexate, dactinomycin and chlorambucil. Several courses are given until the beta-HCG levels are normal for 3 successive weeks. There are other successful combination chemotherapy regimens. In most patients with multiple metastases there is a success rate of 80%, which is excellent when compared with old figures just a few decades ago. However, patients with liver and brain metastases only give response rates of 60% to 70%.

4. For patients with brain or liver metastases special protocols have been developed where combination chemotherapy with 6 or 7 drugs is used and at the same time radiotherapy to the metastases in the liver or in the brain is also given.

The end point for brain metastses has to be defined by taking cerebrospinal fluid samples through lumbar puncture and sending these samples for beta-HCG analysis until levels turn negative. Here is the 10-year survival data when the above guidelines were followed (Ref. 2):

10-year survival for gestational trophoblastic disease
Stage:	10-year survival ( % ):
0 A	98 %
0 B	95 %
I *	90 %
II **	88 %
III	68 %
IV	60 %

* locally invasive hydatidiform mole

** stage II to IV are called choriocarcinoma

Compared to only a few decades ago these survival statistics are amazingly good as at that time for stage I a typical cancer survival rates for 10-years would have been only 40% and for stage IV a highly successful survival rate would have been about 10%! As always, with any kind of cancer, early detection and prompt treatment is extremely important as can be seen from this table.

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Disclaimer:

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References:

1. Cancer: Principles &Practice of Oncology.4th edition. Edited by Vincent T. DeVita, Jr. et al. Lippincott, Philadelphia,PA, 1993. Vol. 1. Chapter on gynecological tumors.

2. Cancer: Principles&Practice of Oncology. 5th edition, volume 1. Edited by Vincent T. DeVita, Jr. et al. Lippincott-Raven Publ., Philadelphia,PA, 1997. Chapter on gynecological tumors.

3. EI Kohorn Int J Gynecol Cancer 2001 Jan;11(1):73-77.

4. MS Cha et al. Biochem Biophys Res Commun 2001 Apr 13;282(4):1061-1066.

5. IK El-Lamie et al. Int J Gynecol Cancer 2000 Nov;10(6):488-496.

6. AM Case et al. Hum Reprod 2001 Feb;16(2):360-364.

Last Modified: Dec. 29, 2008