Management of gestational trophoblastic disease

Gestational trophoblastic disease (GTD) embraces a spectrum of neoplasms of the placenta. Hydatidiform moles are managed by molar evacuation and expectant surveillance of quantitative serum hCG levels. Approximately 80% of complete moles and more than 90% to 95% of partial moles will enter complete remission without further therapy. Malignant GTD can occur after any type of pregnancy. The prognosis is determined by several clinical risk factors, including anatomic site(s) of disease, duration of disease, hCG level, and type of antecedent pregnancy. Patients with nonmetastatic and low-risk metastatic GTD have an excellent outcome when treated with single-agent chemotherapy. Even patients with high-risk disease may have survival rates of approximately 80%, but only if patients in this category are treated with initial aggressive multiagent chemotherapy. Combined modality therapy is often required to optimize outcome in high-risk patients. Most women with malignant GTD can be cured and retain reproductive function.