Current management of gestational trophoblastic disease

Zacharakis D, Thomakos N, Rodolakis A, Antsaklis A

1st Department of Obstetrics and Gynecology, University of Athens, Alexandra hospital, Athens, Greece

Correspondence: Zacharakis Dimitrios, 78 Vasilissis Sofias Avenue, GR-11528, Athens, Greece. E-mail:


Gestational trophoblastic disease comprises a spectrum of interrelated conditions originating from the placenta. These conditions are classified as gestational trophoblastic disease (GTD), when they present a benign behaviour and as gestational trophoblastic neoplasia (GTN), when a malignant potential is present. Vaginal bleeding and hyperemesis gravidarum are the most common presenting symptoms, while suction curettage is the preferred method of evacuation. A plateau or rise in β-hCG levels is the most sensitive marker for persistent trophoblastic disease. In 1992 the International Federation of Gynecology and Obstetrics (FIGO) reports data on GTN using an anatomic staging system, whereby the disease was classified into 4 stages. In 2000 this classification system was combined with a prognostic scoring system proposed by WHO that reliably predicts the potential for chemotherapy resistance. Treatment in patients with low-risk disease includes single-agent chemotherapy usually with methotrexate, while for patients with high-risk metastatic disease, the recommended treatment is combination chemotherapy. At present, with current approaches to chemotherapy, most women with GTN can be cured and their reproductive function preserved.

Key words: gestational trophoblastic disease, gestational trophoblastic neoplasia, molar pregnancy, chemotherapy, phantom-hCG

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