Keywords
Gestational Trophoblastic Disease
Epidemiology
Treatment
Survival
Epidemiology
Treatment
Survival
How to Cite
Villegas-Mejía, C. R., Chacón-Cardona, J. A., & Villegas-Jaramillo, M. (2017). Gestational trophoblastic disease in oncological center on Caldas – Colombia during 2001 - 2014. Médicas UIS, 30(3), 39–49. https://doi.org/10.18273/revmed.v30n3-2017004
Abstract
Introduction: The gestational trophoblastic disease represents a spectrum of diseases with a common denominator that serves as a marker for diagnosis, monitoring, prognoses and follow-up, the Subunit Beta Human Chorionic Gonadotropin. We review the behavior of gestational trophoblastic disease in a cancer center of third level. Materials and Methods: A retrospective cohort of patients referred to the institution on Caldas department from january 2001 to december 2014, with a diagnosis of gestational trophoblastic disease for analyzing treatment and evolution variables. Results: from 25 patients with median age of 30 years; 68% had symptoms for less than three months; 84% are diagnosed by ultrasound and 80% by curettage; 52% with persistent mole and 24% with choriocarcinoma; 80% clinical stage I, stage III 8% and 8% in stage IV with metastatic to lung 36%, 18% to central nervous system and 9% to liver; 76% classified as low risk; mean follow-up between diagnosis and remission was 6.3 months, between surgery and remission of 6.4 months and between the first chemotherapy and remission 2.9 months. The overall survival was 92%. Conclusion: The factors of greater importance in the occurrence and evolution of gestational trophoblastic disease are the level of the Subunit Beta Human Chorionic Gonadotropin, histology, presence or non-metastatic disease, the use of multi-agent chemotherapy and finally the international prognostic index. MÉD.UIS. 2017;30(3):39-49.
References
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3. Horn LC, Bilek K. Histologic classification and staging of gestacional trophoblastic disease. Gen Diagn Pathol 1997;143(2-3):87-101.
4. Seckl MJ, Seblre NJ, Berkowitz RS. Gestational trophoblastic disease. Lancet 2010;376(9742):717-29.
5. Brinton LA, Bracken MB, Connelly RR. Choriocarcinoma incidence in the United States. Am J Epidemiol. 1986;123(6):1094-100.
6. Altieri A, Franceschi S, Ferlay J, Smith J, La Vecchia C. Epidemiology and etiology of gestational trophoblastic diseases. Lancet Oncol 2003;4(11):670-8.
7. Palmer JR. Advances in the epidemiology of gestational trophoblastic disease. J Reprod Med 1994;39(3):155-62.
8. Suárez RAE, Santana TRM, Pantoja TCO, Pérez ACE, Vázquez MH. Incidencia de enfermedad trofoblástica gestacional detectada por el estudio histopatológico rutinario de los especímenes obtenidos de abortos. Ginecol Obstet Mex. 2008;76(2):81-7.
9. Rodríguez-Frías E, Mendoza R, León F. Enfermedad del trofoblasto en el Hospital Regional Cayetano Heredia de Piura. Acta Médica Peruana 1985;12:35.
10. Gori RM, Lorusso A. Ginecología de Gori. 2da Ed. Buenos Aires: El Ateneo; 2001. 265-74.
11. Rodríguez M, Aulicino M, Bibbo M, Iglesias F. Enfermedad Trofoblástica Gestacional en un servicio hospitalario de la ciudad de Corrientes. Revista de la Sociedad de Obstetricia y Ginecología.1996;150:192.
12. Bianconi MI, Otero S, Moscheni O, Alvarez L, Storino C, Jankilevich G. Gestational Trophoblastic Disease, A 21-year Review of the Clinical Experience at an Argentinean Public Hospital. J Reprod Med. 2012;57(7-8):341-9
13. Suárez RAE, Santana TRM, Pantoja TCO, Pérez ACE, Vázquez MH. Incidencia de enfermedad trofoblástica gestacional detectada por el estudio histopatológico rutinario de los especímenes obtenidos de abortos. Ginecol Obstet Mex. 2008;76(2):81-7.
14. Disaia J. Neoplasia Trofoblastica Gestacional. Edit Panamericana. 1989
15. Buckey J. Epidemiología del embarazo molar y del Coriocarcinoma. Clínicas Obst y srinecol. 1984;1:209-35.
16. Berkowitz RS, Goldstein DP. Chorionic tumors. N Engl J Med 1996; 335(23):1740-8.
17. Soto-Wright V, Bernstein M, Goldstein DP, Berkowitz RS. The changing clinical presentation of complete molar pregnancy. Obstet Gynecol 1995; 86(5):775-9.
18. Mangili G, Spannolo D, Valsecchi L, Maggi R. Transvaginal ultrasonography in persistent trophoblastic tumor. Am J. Obstet Gynaecol.1993;169(5):1218-23.
19. Benson CB, Genest DR, Bernstein MR, Soto-Wright V, Goldstein DP, Berkowitz RS. Sonographic appearance of first trimester complete hydatidiform moles. Ultrasound Obstet Gynecol 2000;16(2):188-91.
20. Baergen RN, Kelly T, McGinniss MJ, Jones OW, Benirschke K. Complete hydatidiform mole with a coexistent embryo. Hum Pathol. 1996;27(7):731-4
21. FIGO Oncology Committee. FIGO staging for gestational trophoblastic neoplasia 2000. FIGO Oncology Committee. Int J Gynaecol Obstet. 2002;77(3):285-7.
22. Edge SB, Byrd DR, Compton CC, et al; American Joint Committee on Cancer. Gestational Trophoblastic Tumors. In: AJCC Cancer Staging Manual. 7th ed. Springer. New York 2010. 437.
23. DuBeshter B, Berkowitz RS, Goldstein DP, Cramer DW, Bernstein MR. Metastatic gestational trophoblastic disease: Experience at the New England Trophoblastic Disease Center, 1965-1985. Obstet Gynecol. 1987;69:390.
24. Mortakis AE, Braga CA. “Poor prognosis” metastatic gestational trophoblastic disease: the prognostic significance of the scoring system in predicting chemotherapy failures. Obstet Gynecol. 1990;76(2):272-7.
25. Goldstein DP, Zanten-Przybysz IV, Bernstein MR, Berkowitz RS. Revised FIGO staging system for gestational trophoblastic tumors. Recommendations regarding therapy. J Reprod Med. 1998;43(1):37-43.
26. Homesley HD. Single-agent therapy for nonmetastatic and low-risk gestational trophoblastic disease. J Reprod Med. 1998;43(1):69-74.
27. Deng L, Zhang J, Wu T, Lawrie TA. Combination chemotherapy for primary treatment of high-risk gestational trophoblastic tumour. Cochrane Database Syst Rev, 2013;31(1):CD005196.
28. Foulmann K, Guastalla JP, Caminet N, Trillet-Lenoir V, Raudrant D, Golfier F, et al. What is the best protocol of single-agent methotrexate chemotherapy in nonmetastatic or low-risk metastatic gestational trophoblastic tumors? A review of the evidence. Gynecol Oncol. 2006;102(1):103-6.
29. Alifrangis C, Agarwal R, Short D, Fisher RA, Sebire NJ, Harvey R, et al. EMA/CO for High-Risk Gestational Trophoblastic Neoplasia: Good Outcomes with Induction Low-Dose EtoposideCisplatin and Genetic Analysis. J Clin Oncol. 2013;31(2):280-6
30. Soper JT, Mutch DG, Schink JC; American College of Obstetricians and Gynecologists. Diagnosis and treatment of gestational trophoblastic disease: ACOG Practice Bulletin No. 53. Gynecol Oncol. 2004;93(3):575-85.
31. Lurain JR. Gestational trophoblastic disease II: classification and management of gestational trophoblastic neoplasia. Am J Obstet Gynecol. 2011;204(1):11-8.
32. Lybol C, Westerdijk K, Sweep FC, Ottevanger PB, Massuger LF, Thomas CM. Human chorionic gonadotropin (hCG) regression normograms for patients with high-risk gestational trophoblastic neoplasia treated with EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine) chemotherapy. Annals of Oncology. 2012;23(11):2903–6
33. Gillespie AM, Kumar S and Hancock BW. Treatment of persistent trophoblastic disease later than 6 months after diagnosis of molar pregnancy. Br J Cancer. 2000; 82(8):1393–5.
34. Xiang Y, Sun Z, Wan X, Yang X. EMA/EP chemotherapy for chemorefractory gestational trophoblastic tumor. J Reprod Med. 2004;49(6):443-6.
35. Ngan HY, Odicino F, Maisonneuve P, Creasman WT, Beller U, Quinn MA, et al. Gestational trophoblastic neoplasia. FIGO 26th Annual report on the results of treatment in gynecological cancer. Int J Gynaecol Obstet. 2006;95 Suppl 1:S193-203.
36. Maestá I, Growdon WB, Goldstein DP, Bernstein MR, Horowitz NS, Rudge MV, et al. Prognostic factors associated with time to hCG remission in patients with low-risk postmolar gestational trophoblastic neoplasia. Gynecol Oncol. 2013;130(2):312-6.
37. Seckl M, Seribe R, Fisher RA, Golfier F, Massuger L, sessa C, et al. Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24 Suppl 6:S39-50.
38. Bermúdez AJ, Cortés C, Díaz LE, Crane C, Ching R, Aragón M, et al. Estudio bioquímico y genético de la enfermedad trofoblástica gestacional. Med. 2006;28(1):14-18.
39. Carrillo DC, García CA. Coriocarcinoma metastásico posparto: presentación de un caso. Rev Colomb Radiol. 2013;24(2):3705-8.
40. Oróstegui S, Arenas YA, Galindo LM. Enfermedad trofoblástica gestacional. MedUNAB. 2008;11(2):140-8.
2. Berkowitz RS, Golstein DP. The management of molar pregnancy and gestacional trophoblashc tumours. En: Knapp RC, Berkowitz RS, editores. Gynecologic oncology, 2 ed. Nueva York: Mc Graw - Hill; 1992 p 328-38.
3. Horn LC, Bilek K. Histologic classification and staging of gestacional trophoblastic disease. Gen Diagn Pathol 1997;143(2-3):87-101.
4. Seckl MJ, Seblre NJ, Berkowitz RS. Gestational trophoblastic disease. Lancet 2010;376(9742):717-29.
5. Brinton LA, Bracken MB, Connelly RR. Choriocarcinoma incidence in the United States. Am J Epidemiol. 1986;123(6):1094-100.
6. Altieri A, Franceschi S, Ferlay J, Smith J, La Vecchia C. Epidemiology and etiology of gestational trophoblastic diseases. Lancet Oncol 2003;4(11):670-8.
7. Palmer JR. Advances in the epidemiology of gestational trophoblastic disease. J Reprod Med 1994;39(3):155-62.
8. Suárez RAE, Santana TRM, Pantoja TCO, Pérez ACE, Vázquez MH. Incidencia de enfermedad trofoblástica gestacional detectada por el estudio histopatológico rutinario de los especímenes obtenidos de abortos. Ginecol Obstet Mex. 2008;76(2):81-7.
9. Rodríguez-Frías E, Mendoza R, León F. Enfermedad del trofoblasto en el Hospital Regional Cayetano Heredia de Piura. Acta Médica Peruana 1985;12:35.
10. Gori RM, Lorusso A. Ginecología de Gori. 2da Ed. Buenos Aires: El Ateneo; 2001. 265-74.
11. Rodríguez M, Aulicino M, Bibbo M, Iglesias F. Enfermedad Trofoblástica Gestacional en un servicio hospitalario de la ciudad de Corrientes. Revista de la Sociedad de Obstetricia y Ginecología.1996;150:192.
12. Bianconi MI, Otero S, Moscheni O, Alvarez L, Storino C, Jankilevich G. Gestational Trophoblastic Disease, A 21-year Review of the Clinical Experience at an Argentinean Public Hospital. J Reprod Med. 2012;57(7-8):341-9
13. Suárez RAE, Santana TRM, Pantoja TCO, Pérez ACE, Vázquez MH. Incidencia de enfermedad trofoblástica gestacional detectada por el estudio histopatológico rutinario de los especímenes obtenidos de abortos. Ginecol Obstet Mex. 2008;76(2):81-7.
14. Disaia J. Neoplasia Trofoblastica Gestacional. Edit Panamericana. 1989
15. Buckey J. Epidemiología del embarazo molar y del Coriocarcinoma. Clínicas Obst y srinecol. 1984;1:209-35.
16. Berkowitz RS, Goldstein DP. Chorionic tumors. N Engl J Med 1996; 335(23):1740-8.
17. Soto-Wright V, Bernstein M, Goldstein DP, Berkowitz RS. The changing clinical presentation of complete molar pregnancy. Obstet Gynecol 1995; 86(5):775-9.
18. Mangili G, Spannolo D, Valsecchi L, Maggi R. Transvaginal ultrasonography in persistent trophoblastic tumor. Am J. Obstet Gynaecol.1993;169(5):1218-23.
19. Benson CB, Genest DR, Bernstein MR, Soto-Wright V, Goldstein DP, Berkowitz RS. Sonographic appearance of first trimester complete hydatidiform moles. Ultrasound Obstet Gynecol 2000;16(2):188-91.
20. Baergen RN, Kelly T, McGinniss MJ, Jones OW, Benirschke K. Complete hydatidiform mole with a coexistent embryo. Hum Pathol. 1996;27(7):731-4
21. FIGO Oncology Committee. FIGO staging for gestational trophoblastic neoplasia 2000. FIGO Oncology Committee. Int J Gynaecol Obstet. 2002;77(3):285-7.
22. Edge SB, Byrd DR, Compton CC, et al; American Joint Committee on Cancer. Gestational Trophoblastic Tumors. In: AJCC Cancer Staging Manual. 7th ed. Springer. New York 2010. 437.
23. DuBeshter B, Berkowitz RS, Goldstein DP, Cramer DW, Bernstein MR. Metastatic gestational trophoblastic disease: Experience at the New England Trophoblastic Disease Center, 1965-1985. Obstet Gynecol. 1987;69:390.
24. Mortakis AE, Braga CA. “Poor prognosis” metastatic gestational trophoblastic disease: the prognostic significance of the scoring system in predicting chemotherapy failures. Obstet Gynecol. 1990;76(2):272-7.
25. Goldstein DP, Zanten-Przybysz IV, Bernstein MR, Berkowitz RS. Revised FIGO staging system for gestational trophoblastic tumors. Recommendations regarding therapy. J Reprod Med. 1998;43(1):37-43.
26. Homesley HD. Single-agent therapy for nonmetastatic and low-risk gestational trophoblastic disease. J Reprod Med. 1998;43(1):69-74.
27. Deng L, Zhang J, Wu T, Lawrie TA. Combination chemotherapy for primary treatment of high-risk gestational trophoblastic tumour. Cochrane Database Syst Rev, 2013;31(1):CD005196.
28. Foulmann K, Guastalla JP, Caminet N, Trillet-Lenoir V, Raudrant D, Golfier F, et al. What is the best protocol of single-agent methotrexate chemotherapy in nonmetastatic or low-risk metastatic gestational trophoblastic tumors? A review of the evidence. Gynecol Oncol. 2006;102(1):103-6.
29. Alifrangis C, Agarwal R, Short D, Fisher RA, Sebire NJ, Harvey R, et al. EMA/CO for High-Risk Gestational Trophoblastic Neoplasia: Good Outcomes with Induction Low-Dose EtoposideCisplatin and Genetic Analysis. J Clin Oncol. 2013;31(2):280-6
30. Soper JT, Mutch DG, Schink JC; American College of Obstetricians and Gynecologists. Diagnosis and treatment of gestational trophoblastic disease: ACOG Practice Bulletin No. 53. Gynecol Oncol. 2004;93(3):575-85.
31. Lurain JR. Gestational trophoblastic disease II: classification and management of gestational trophoblastic neoplasia. Am J Obstet Gynecol. 2011;204(1):11-8.
32. Lybol C, Westerdijk K, Sweep FC, Ottevanger PB, Massuger LF, Thomas CM. Human chorionic gonadotropin (hCG) regression normograms for patients with high-risk gestational trophoblastic neoplasia treated with EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine) chemotherapy. Annals of Oncology. 2012;23(11):2903–6
33. Gillespie AM, Kumar S and Hancock BW. Treatment of persistent trophoblastic disease later than 6 months after diagnosis of molar pregnancy. Br J Cancer. 2000; 82(8):1393–5.
34. Xiang Y, Sun Z, Wan X, Yang X. EMA/EP chemotherapy for chemorefractory gestational trophoblastic tumor. J Reprod Med. 2004;49(6):443-6.
35. Ngan HY, Odicino F, Maisonneuve P, Creasman WT, Beller U, Quinn MA, et al. Gestational trophoblastic neoplasia. FIGO 26th Annual report on the results of treatment in gynecological cancer. Int J Gynaecol Obstet. 2006;95 Suppl 1:S193-203.
36. Maestá I, Growdon WB, Goldstein DP, Bernstein MR, Horowitz NS, Rudge MV, et al. Prognostic factors associated with time to hCG remission in patients with low-risk postmolar gestational trophoblastic neoplasia. Gynecol Oncol. 2013;130(2):312-6.
37. Seckl M, Seribe R, Fisher RA, Golfier F, Massuger L, sessa C, et al. Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24 Suppl 6:S39-50.
38. Bermúdez AJ, Cortés C, Díaz LE, Crane C, Ching R, Aragón M, et al. Estudio bioquímico y genético de la enfermedad trofoblástica gestacional. Med. 2006;28(1):14-18.
39. Carrillo DC, García CA. Coriocarcinoma metastásico posparto: presentación de un caso. Rev Colomb Radiol. 2013;24(2):3705-8.
40. Oróstegui S, Arenas YA, Galindo LM. Enfermedad trofoblástica gestacional. MedUNAB. 2008;11(2):140-8.
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