Management of gestational trophoblastic disease in developing countries.
Document Type
Article
Publication Date
12-1-2003
Abstract
In Malaysia, the incidence of molar pregnancy and gestational trophoblastic neoplasia is 2.8 and 1.59 per 1000 deliveries, respectively; the disease is more common among the Chinese compared to the Malays and Indians. While uterine suction is the preferred method of uterine evacuation of hydatidiform mole, complete evacuation was not achieved at the first attempt in 25% of cases. Partial moles comprise 30% of all moles; these need follow up similar to that for complete moles as they are potentially malignant. In the management of invasive moles, chemotherapy should not be withheld in the presence of metastases or failure of regression of hCG. Placental site tumours are rare. Prophylactic hysterectomy and prophylactic chemotherapy are not recommended. However, in those patients with unsatisfactory hCG regression curves indicating 'at risk' in developing gestational trophoblastic neoplasia (GTN), 'selective preventive chemotherapy' appears appropriate. Chemotherapy remains the main modality of treatment for GTN. As tumour bulk and location of disease are important determinants in outcome, we categorized our patients into low, medium- and high-risk groups with survivals of 100, 98 and 61.7% respectively. Surgery and radiotherapy have a limited role.
Keywords
Brain Neoplasms/secondary, Choriocarcinoma/prevention & control
Publication Title
Best Practice & Research Clinical Obstetrics & Gynaecology
Volume
17
Issue
6
Publisher
Elsevier
Additional Information
Department of Obstetrics and Gynaecology, University of Malaya, 50603 Kuala Lumpur, Malaysia. sivanes@um.edu.my