جستجوی مقالات مرتبط با کلیدواژه "gestational trophoblastic neoplasia" در نشریات گروه "پزشکی"

Gestational trophoblastic neoplasia (GTN) is a group of tumors highly responsive to chemotherapy. It has been suggested that cancer therapies have detrimental effects on female fertility. Anti-Müllerian hormone (AMH) is considered fertility potential and ovarian reserves in women. The aim of this study was to compare serum AMH levels between the patients with GTN treated with chemotherapy and the patients with hydatidiform mole who underwent suction curettage without receiving any chemotherapy.

In 35 patients with GTN, serum AMH levels were measured before suction curettage and after the administration of chemotherapy and compared with serum AMH levels measured in 35 patients with hydatidiform mole, who did not receive any chemotherapy as a control. In controls, serum levels of AMH were measured before suction curettage and at the time when beta human chorionic gonadotrophin (ß-hCG) levels approached zero concentration.

The mean serum AMH levels in the GTN group were significantly lower than those measured in the control group after chemotherapy. In addition, serum AMH levels measured after intervention in each group significantly decreased compared to the basal levels (p=0.034). Serum AMH levels showed significant differences between the patients who received chemotherapy regimens with methotrexate (MTX) alone, actinomycin-D (Act-D) alone, or the combination of MTX and Act-D (p=0.001).

Our study showed that fertility preservation is of great importance in patients with GTN treated with chemotherapy. Furthermore, both MTX and Act-D could have potential adverse effects on ovarian reserve.

Low-risk gestational trophoblastic neoplasia could be cured in the case of appropriate management with single-agent chemotherapy. This study was carried out to compare the efficacy of single-dose methotrexate versus Actinomycin-D in low-risk gestational trophoblastic neoplasia to analyze the most effective agent.

This retrospective cohort study was conducted on the medical record of 170 cases with the diagnosis of low-risk gestational trophoblastic neoplasia from 2012 to 2019 to evaluate the response rate of single-dose weekly-methotrexate versus biweekly-Actinomycin-D.

Single agent chemotherapy was required in 170 patients with final risk score of less than 7. Among the 100 cases under weekly-methotrexate therapy, 29 patients were required second-line chemotherapy with Actinomycin-D and combination therapy which means complete remission of 71% with methotrexate, in comparison with 78.5% in the other group. Resistance was mostly seen in patients with documented choriocarcinoma in histology who had not received timely diagnosis and treatment.

Individualized decision in the management of low-risk gestational trophoblastic neoplasia cases, based on histology, HCG, and history is the corn stone in successful treatment.

Methotrexate (MTX) and actinomycin D (ActD) have been used as first-line chemotherapy agents in the treatment of low-risk gestational trophoblastic neoplasia (GTN). Although low-risk GTN is considered a curable disease, its reported primary remission rates of 49 to 93% reflect the difficulties of treatment and different factors influencing it. Hence, this study aimed to determine the remission rates and related factors of single-agent chemotherapy resistance in low-risk GTN patients.

This retrospective study included patients with diagnosed low-risk GTN who received either MTX once a week (IM, 30mg/m2) or ActD once every two weeks (pulsed IV, 1.25mg/m2). Then, the patients were followed-up until complete remission or single-agent treatment failure to assess resistance rate and related factors.  

Eighty-four patients were included in the study (18 patients were receiving MTX and 66 patients were receiving ActD). 85.7% of all participants achieved complete remission after first-line chemotherapy (72.2% in MTX vs 89.4% in ActD). There was a significant association for higher tumor size (P=0.046), the occurrence of metastasis (P=0.019), and pretreatment β-HCG levels (P=0.005) with resistance to treatment.

This study demonstrated higher tumor size, the occurrence of metastasis, and pretreatment β-HCG levels have been associated with increased resistance to first-line chemotherapy agents.

GTN (Gestational trophoblastic neoplasm) complications such as uterine rupture or massive bleeding can be life-threatening and usually need a hysterectomy. In young patients who want to preserve fertility, hysterectomy is not suitable. Under specific circumstances, some physicians choose conservative management. Uterine preservation after complicated GTN is rare by itself. In conclusion, conservative management of GTN patients who develop high-risk complications and desire for future pregnancies must be considered an option. In published case reports, outcomes of conservative surgical management have been very good if managed properly.

Epithelioid trophoblastic tumors (ETTs) are extremely rare gestational trophoblastic neoplasia and a subtype of the placental site trophoblastic tumors (PSTTs). To our knowledge, there have been only 110 patients diagnosed with the ETT. ETT is generally seen in the reproductive period, following term pregnancy. Generally, as in PSTT, β-HCG levels are normal or slightly elevated. The most common complaint is abnormal vaginal bleeding. At the time of diagnosis, findings of metastasis can be seen in 50% of the cases. Transvaginal ultrasonography (TV-USG) and computed tomography (CT) are used for imaging in the literature. Surgical treatment and follow-up are sufficient in the early stages. We present a case of a 37-year-old ETT patient who suffered from irregular vaginal bleeding.

 Early diagnosis of gestational trophoblastic neoplasia and its complications are pivotal for prompt and efficacious treatment. Transvaginal pelvic ultrasound could detect myometrial invasion and endometrial thickening following dilation and evacuation of hydatiform mole and also in the assessment of response to chemotherapy.

 In this study we aimed to investigate transvaginal ultrasound findings of stage I low-risk gestational trophoblastic neoplasia (GTN) and whether there is an association between ultrasound findings and chemotherapy response.
Patients and

 This study included 31 consecutive patients with postmolar stage I low-risk GTN. We recorded International Federation of Gynecology and Obstetrics (FIGO) score, and transvaginal ultrasound findings including color and pulsed Doppler interrogation at the time of β-hCG rise. The number of Act-D cycles that each patient needed to achieve complete remission was also recorded.

 Of the 31 patients with post-evacuation trans-vaginal ultrasound evaluation, 2 (6.5%) patients had no detectable finding, 4 (12.9%) had lesions limited to the endometrium, 12 (38.7%) had lesions with < 50% invasion into myometrium, 7 (22.6%) had lesions with > 50% invasion into myometrium, 4 (12.9%) had lesions that reached uterine serosal surface and 2 (6.5%) had AVM-like myometrial lesions. The number of Act-D cycles patients needed to achieve remission was 6 cycles in patients with no finding, lesion limited to endometrium and less than 50% myometrial invasion and was 8 cycles in patients with > 50% invasion ± involvement of serosal surface. One patient in first group and two in second group need multi-agent chemotherapy. But these differences were not significant (P = 0.172).

 There was a non-significant increase in treatment duration and need of multiagent chemotherapy with more extensive ultrasound findings among patients with stage I low risk GTN.

Introduction:

 Gestational trophoblastic diseases (GTD) is the only group of female reproductive neoplasms derived from paternal genetic material (Androgenic origin). GTD is a continuum from benign to malignant; molar pregnancy is benign, but choriocarcinoma is malignant. Approximately 45% of patients have metastatic disease when Gestational trophoblastic neoplasia (GTN) is diagnosed. GTN is unique in women malignancies because it arises from trophoblast but not from genital organs. It is curable with chemotherapy, low-risk GTN completely response to single-agent chemotherapy and does not require histological confirmation. In persistent GTN, clinical staging and workup of metastasis should be performed. The aim of the present study was to review the new management of GTD.

Conclusion:

 In the case of brain, liver, or renal metastases, any woman of reproductive age who presents with an apparent metastatic malignancy of unknown primary site should be screened for the possibility of GTN with a serum HCG level. Excisional biopsy is not indicated to histologically confirm the diagnosis of malignant GTN if the patient is not pregnant and has a high HCG value. Given the vascular nature of these lesions, a biopsy can have significant morbidity. In every woman with abnormal bleeding or neurologic symptom without documented reason, the probability of malignant GTN should be in mind and determination of HCG titer is recommended. In selected cases with low-risk GTN, repeat curettage is done to reduce the need for chemotherapy courses. In recent years personalized medicine is encouraged for treatment of GTN.