Poor-prognosis metastatic gestational trophoblastic neoplasia

Despite recent advances in therapy, patients with poor-prognosis metastatic GTN continue to present the clinician with challenging management problems. The optimal care for these patients is best delivered in centers specializing in the treatment of trophoblastic disease. Not only does the coordination of chronic aggressive multiagent chemotherapy, irradiation therapy, and surgical therapy require considerable expertise, but the proximity of a reliable and sensitive hCG assay aids in the rapid identification of the development of drug-resistant disease. Although recognition of the poor-prognosis group and the development of effective multiagent chemotherapy have increased the survival of these patients, progress in therapy for these patients will require continuing intensive efforts.