Gestational trophoblastic tumors

Gestational trophoblastic tumor is a term applied to invasive mole, choriocarcinoma, and placental-site trophoblastic tumor. The overall cure rate in the treatment of these gestational trophoblastic tumors now exceeds 90%. This high success rate is the result of (1) inherent sensitivity of trophoblastic tumors to chemotherapy, (2) ability to monitor therapy effectively with the use of human chorionic gonadotropin as a tumor marker, and (3) identification of prognostic factors which allows categorization of patients into high- and low-risk groups for selection of treatment. Virtually all patients with nonmetastatic and low-risk metastatic disease can be cured using single-agent methotrexate or Actinomycin-D chemotherapy. Intensive therapy with combination chemotherapy including etoposide, high-dose methotrexate and Actinomycin D and, where indicated, adjuvant radiotherapy and surgery has resulted in cure rates of 80-90% in patients with high-risk metastatic disease. The factors which are most important in determining response to treatment are: (1) clinicopathologic diagnosis of choriocarcinoma, (2) metastases to sites other than the lung or vagina, (3) number of metastases, (4) previous failed chemotherapy, and (5) WHO score greater than or equal to 8.