| Persistence and malignant sequelae of gestational trophoblastic disease: Clinical presentation, diagnosis, treatment and outcome. | |
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MedLine Citation:
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PMID: 20219003 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The major concern in gestational trophoblastic disease is management of persistent disease and malignant sequelae. However, prediction of response to treatment is difficult and methods used controversial. AIM AND METHODS: To evaluate the usefulness of clinical presentation, methods of diagnosis and categorisation of risk in determining clinical outcomes, by analysis of a database of 705 registered patients collected over 30 years. RESULTS: From the database, there were 97 patients who developed persistent disease and malignant sequelae on the basis of defined criteria - 80.4% had molar pregnancy and 19.6% non-molar pregnancy. Vaginal bleeding was not a common presentation; 59.8% had no clinical symptoms. According to protocol, monitoring by serial human chorion gonadotrophin (HCG) levels followed by imaging screen was used in all patients; histology was also available in 41.2% from hysterectomy and curettage specimens. There were 16 of 76 patients with persisting disease who had metastases (21.1%), and 2 of 20 patients with choriocarcinoma who had an antecedent molar pregnancy (10.0%). Based on five risk factors, 25 patients were categorised as 'high risk' and assigned to receive multi-drug chemotherapy. There were two deaths (2.1% for all malignant sequelae); both were from molar pregnancies. One patient failed to respond and the other suffered a complication of intensive chemotherapy. CONCLUSION: Serial HCG levels remain the best monitor to determine therapeutic response. Categorisation of 'high risk' by five factors is useful in treatment. Albeit a small series, clinical outcome is favourable with a five-year survival of 89.7%. |
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Authors:
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Soo-Keat Khoo; Mukhtiar Sidhu; David Baartz; Wai-Lum Yip; Lee Tripcony |
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18446663 - Complete hydatidiform mole with co-existing healthy fetus: a case report. 11766153 - Gestational trophoblastic disease. 10711553 - Cost-effectiveness of single-dose methotrexate compared with laparoscopic treatment of ... |
Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: The Australian & New Zealand journal of obstetrics & gynaecology Volume: 50 ISSN: 1479-828X ISO Abbreviation: Aust N Z J Obstet Gynaecol Publication Date: 2010 Feb |
Date Detail:
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Created Date: 2010-03-11 Completed Date: 2010-07-13 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0001027 Medline TA: Aust N Z J Obstet Gynaecol Country: Australia |
Other Details:
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Languages: eng Pagination: 81-6 Citation Subset: IM |
Affiliation:
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Betty Byrne Henderson Women's Health Research Centre, University of Queensland, Brisbane, Australia. si.khoo@uq.edu.au |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Antineoplastic Combined Chemotherapy Protocols / therapeutic use Chorionic Gonadotropin / blood Female Follow-Up Studies Gestational Trophoblastic Neoplasms / diagnosis*, pathology, therapy* Humans Hysterectomy Neoplasm Metastasis Pregnancy Retrospective Studies Risk Assessment Survival Analysis |
| Chemical | |
Reg. No./Substance:
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0/Chorionic Gonadotropin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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