Upfront Hysterectomy Versus Primary Chemotherapy in the Management of Low-Risk Gestational Trophoblastic Neoplasia at Old Age Patients: A Prospective Study
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Surgical oncology
Gestational trophoblastic neoplasia
Surgical oncology
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Surgical oncology
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A delay on diagnosing Gestational Trophoblastic Neoplasia (GTN) may cause increase of morbidity to the patient. The important things that OBGYN usually forgot is that GTN may develop not only from previous molar gestation (50-60%), but also from abortions or ectopic pregnancy (25-30%) and term or preterm deliveries (10-25%).1,2This can cause a delay on diagnosing that may increase the GTN score from low risk become high risk, such as this case, as follow.
Gestational trophoblastic neoplasia
Molar Pregnancy
Chorioepithelioma
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Surgical oncology
Clinical Oncology
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Surgical oncology
Precision oncology
Surgical procedures
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To evaluate hysterectomy prevalence, indications and impact on clinical outcomes in a reference center in southern Brazil.Institutional Ethical Committee approval was granted for this study. In a cohort study spanning 21 years, all patients who underwent hysterectomy for gestational trophoblastic neoplasia (GTN) were included, and technical differences between hysterectomy performed in the reference center and those performed elsewhere were evaluated as well.Of 1,023 patients with gestational trophoblastic disease, 57 (5.6%) underwent hysterectomy (95% CI, 4.3-7.1). Hysterectomy incidence in 230 GTN patients was 17.7% (95%CI, 15.1-23.3). Indications for 41 hysterectomies in the reference center were as follows: primary treatment in 14 (34.1%) cases and secondary treatment in 27 (65.9%); of these, the main indications were GTN recurrence (7 [25.9%] cases), hemorrhage (6 [22.2%]), resistance to single-agent chemotherapy in patients who refused more aggressive treatment (6 [22.2%]), and tumor mass reduction (5 [18.5%]). Twelve (92.3%) of the 13 hysterectomies with bilateral oophorectomy were performed elsewhere (p < 0.001). Thirty-five (85.4%) patients had no complications, and median hospitalization time was short (3 +/- 4 days). None of the 4 deaths were associated with hysterectomy. In the reference center, when associated with hysterectomy, GTN cure rates reached 93% after 63 +/- 87 months of follow-up.When treatment is in a reference center, hysterectomy frequency and morbidity may be low, and indications due to hemorrhage are significantly lower. Furthermore, at a reference center there is significantly greater ovarian preservation at the time of hysterectomy, and significantly more patients who undergo hysterectomy have low-risk GTN.
Gestational trophoblastic neoplasia
Gestational Trophoblastic Disease
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Gestational Trophoblastic Disease
Gestational trophoblastic neoplasia
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The administration of chemotherapy following hydatidiform mole evacuation implies a diagnosis of trophoblastic neoplasia. A review of the literature and an analysis of a questionnaire sent to physicians treating trophoblastic disease shows that the criteria used to make this decision vary significantly. The factors that make it important to arrive at a consensus are discussed. Alternative investigations other than hCG that may distinguish neoplasia such as doppler flow ultrasound and magnetic resonance imaging are examined critically. A definition of neoplasia is presented that relates tumor load as measured by hCG to the length of hCG plateau. The changing criteria for distinguishing metastasis are discussed.
Gestational trophoblastic neoplasia
Gestational Trophoblastic Disease
Trophoblastic Tumor
Trophoblastic neoplasm
Doppler ultrasound
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Gestational trophoblastic neoplasia (GTN) are a broad spectrum of placental lesions. Chemotherapy is the primary treatment for GTN and the vast majority of women with GTN are cured with their initial chemotherapy treatment. However, some patients become chemotherapy-resistant and fail to achieve a complete remission following initial chemotherapy and need salvage chemotherapy. A small minority of patients are still unresponsive to salvage multidrug chemotherapy. Currently, adjuvant surgical procedures could be excellent adjuncts to salvage chemotherapy in removing known foci of chemotherapy-resistant disease in selected patients with persistent GTN. This article will review the surgical management of chemotherapy-resistant GTN, focusing on the relevant indication of surgery, factors affecting efficacy and the use of surgical procedures in selected patients.
Gestational trophoblastic neoplasia
Gestational Trophoblastic Disease
Salvage therapy
Trophoblastic neoplasm
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