Consensus; Europe; Gestational trophoblastic disease; Gestational trophoblastic neoplasia; Referral and consultation; Female; Gestational Trophoblastic Disease/therapy; Guidelines as Topic; Humans; Pregnancy; Referral and Consultation; Oncology; Cancer Research
Abstract :
[en] [en] BACKGROUND AND AIM: Gestational trophoblastic disease (GTD) is a heterogeneous group of disorders characterised by abnormal proliferation of trophoblastic tissue. Since GTD and its malignant sequel gestational trophoblastic neoplasia (GTN) are rare diseases, little evidence is available from randomised controlled trials on optimal treatment and follow-up. Treatment protocols vary within Europe, and even between different centres within countries. One of the goals of the 'European Organisation for Treatment of Trophoblastic Diseases' (EOTTD) is to harmonise treatment in Europe. To provide a basis for European standardisation of definitions, treatment and follow-up protocols in GTD, we composed a set of guidelines for minimal requirements and optimal management of GTD.
METHODS: Members from each EOTTD country attended multiple workshops during annual EOTTD meetings. Clinical guidelines were formulated by consensus and evidence where available. The following guidelines were discussed: diagnostics of GTD and GTN, treatment of low-risk GTN, high-risk GTN, ultra-high-risk GTN, placental site and epithelioid trophoblastic tumours and follow-up.
RESULTS: Between 40 and 65 EOTTD members from 17 European countries and 7 non-European countries attended the clinical workshops held on 6 occasions. Flow diagrams for patient management were composed to display minimum and best practice for most treatment situations. New agreed definitions of recurrence and chemotherapy resistance were formulated.
CONCLUSIONS: Despite the many differences between and within the participating countries, an important step in uniform treatment of GTD and GTN within Europe was made by the Clinical Working Party of the EOTTD. This is an example on how guidelines and harmonisation can be achieved within international networks.
Disciplines :
Reproductive medicine (gynecology, andrology, obstetrics)
Author, co-author :
Lok, Christianne; Department of Gynecologic Oncology, Centre for Gynecologic Oncology Amsterdam, Location Antoni van Leeuwenhoek - The Netherlands Cancer Institute, Amsterdam, the Netherlands. Electronic address: c.lok@nki.nl
van Trommel, Nienke; Department of Gynecologic Oncology, Centre for Gynecologic Oncology Amsterdam, Location Antoni van Leeuwenhoek - The Netherlands Cancer Institute, Amsterdam, the Netherlands
Massuger, Leon; Department of Gynecologic Oncology, Radboud University Medical Hospital, Nijmegen, the Netherlands
Golfier, François; Department of Gynecologic and Oncologic Surgery and Obstetrics, French Trophoblastic Disease Centre, Lyon University Hospitals, Lyon Sud Hospital, France
Seckl, Michael; Charing Cross Gestational Trophoblastic Disease Centre, Charing Cross Hospital, Imperial College London, London, UK. Electronic address: m.seckl@imerial.ac.uk
Clinical Working Party of the EOTTD
Goffin, Frédéric ; Centre Hospitalier Universitaire de Liège - CHU > > Service de gynécologie-obstétrique (CHR) ; as member of The Clinical Working Party of the EOTTD
Language :
English
Title :
Practical clinical guidelines of the EOTTD for treatment and referral of gestational trophoblastic disease.
Eysbouts, Y.K., Bulten, J., Ottevanger, P.B., Thomas, C.M., Ten Kate-Booij, M.J., van Herwaarden, A.E., et al. Trends in incidence for gestational trophoblastic disease over the last 20 years in a population-based study. Gynecol Oncol 140:1 (2016), 70–75.
Joneborg, U., Folkvaljon, Y., Papadogiannakis, N., Lambe, M., Marions, L., Temporal trends in incidence and outcome of hydatidiform mole: a retrospective cohort study. Acta Oncol 57:8 (2018), 1094–1099.
Savage, P., Williams, J., Wong, S.L., Short, D., Casalboni, S., Catalano, K., et al. The demographics of molar pregnancies in England and Wales from 2000-2009. J Reprod Med 55:7–8 (2010), 341–345.
Moliner, A.M., Creating a European Union framework for actions in the field of rare diseases. Adv Exp Med Biol 686 (2010), 457–473.
Elias, K.M., Berkowitz, R.S., Horowitz, N.S., State-of-the-Art workup and initial management of newly diagnosed molar pregnancy and postmolar gestational trophoblastic neoplasia. J Natl Compr Canc Netw 17:11 (2019), 1396–1401.
Ngan, H.Y.S., Seckl, M.J., Berkowitz, R.S., Xiang, Y., Golfier, F., Sekharan, P.K., Lurain, J.R., Massuger, L., Update on the diagnosis and management of gestational trophoblastic disease. Int J Gynaecol Obstet 143:Suppl. 2 (2018), 79–85.
Ronnett, B.M., Hydatidiform moles: ancillary techniques to refine diagnosis. Arch Pathol Lab Med 142:12 (2018), 1485–1502.
RCOG, Management of gestational trophoblastic neoplasia, guideline no 38. 2010 Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_38.pdf.
Ngan, H.Y., Bender, H., Benedet, J.L., Jones, H., Montruccoli, G.C., Pecorelli, S., et al. Gestational trophoblastic neoplasia, FIGO 2000 staging and classification. Int J Gynaecol Obstet 83:Suppl. 1 (2003), 175–177.
Golfier, F., Clerc, J., Hajri, T., Massardier, J., Frappart, L., Duvillard, P., et al. Contribution of referent pathologists to the quality of trophoblastic diseases diagnosis. Hum Reprod 26:10 (2011), 2651–2657.
Osborne, R.J., Filiaci, V.L., Schink, J.C., Mannel, R.S., Behbakht, K., Hoffman, J.S., et al. Second curettage for low-risk nonmetastatic gestational trophoblastic neoplasia. Obstet Gynecol 128:3 (2016), 535–542.
Pezeshki, M., Hancock, B.W., Silcocks, P., Everard, J.E., Coleman, J., Gillespie, A.M., et al. The role of repeat uterine evacuation in the management of persistent gestational trophoblastic disease. Gynecol Oncol 95:3 (2004), 423–429.
Savage, P., Seckl, M.J., The role of repeat uterine evacuation in trophoblast disease. Gynecol Oncol 99:1 (2005), 251–252 reply 252-3.
Schlaerth, J.B., Morrow, C.P., Kletzky, O.A., Nalick, R.H., D'Ablaing, G.A., Prognostic characteristics of serum human chorionic gonadotropin titer regression following molar pregnancy. Obstet Gynecol 58:4 (1981), 478–482.
van Trommel, N.E., Massuger, L.F., Verheijen, R.H., Sweep, F.C., Thomas, C.M., The curative effect of a second curettage in persistent trophoblastic disease: a retrospective cohort survey. Gynecol Oncol 99:1 (2005), 6–13.
Seckl, M.J., Sebire, N.J., Fisher, R.A., Golfier, F., Massuger, L., Sessa, C., et al. Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 24:Suppl. 6 (2013), vi39–vi50.
Mapelli, P., Mangili, G., Picchio, M., Gentile, C., Rabaiotti, E., Giorgione, V., et al. Role of 18F-FDG PET in the management of gestational trophoblastic neoplasia. Eur J Nucl Med Mol Imag 40:4 (2013), 505–513.
Chalouhi, G.E., Golfier, F., Soignon, P., Massardier, J., Guastalla, J.P., Trillet-Lenoir, V., et al. Methotrexate for 2000 FIGO low-risk gestational trophoblastic neoplasia patients: efficacy and toxicity. Am J Obstet Gynecol 200:6 (2009), 643 e1–6.
Sita-Lumsden, A., Short, D., Lindsay, I., Sebire, N.J., Adjogatse, D., Seckl, M.J., et al. Treatment outcomes for 618 women with gestational trophoblastic tumours following a molar pregnancy at the Charing Cross Hospital, 2000-2009. Br J Cancer 107:11 (2012), 1810–1814.
Lawrie, T.A., Alazzam, M., Tidy, J., Hancock, B.W., Osborne, R., First-line chemotherapy in low-risk gestational trophoblastic neoplasia. Cochrane Database Syst Rev(6), 2016, Cd007102.
Li, J., Li, S., Yu, H., Wang, J., Xu, C., Lu, X., The efficacy and safety of first-line single-agent chemotherapy regimens in low-risk gestational trophoblastic neoplasia: a network meta-analysis. Gynecol Oncol 148:2 (2018), 247–253.
Li, L., Wan, X., Feng, F., Ren, T., Yang, J., Zhao, J., et al. Pulse actinomycin D as first-line treatment of low-risk post-molar non-choriocarcinoma gestational trophoblastic neoplasia. BMC Cancer, 18(1), 2018, 585.
Yarandi, F., Mousavi, A., Abbaslu, F., Aminimoghaddam, S., Nekuie, S., Adabi, K., et al. Five-day intravascular methotrexate versus biweekly actinomycin-D in the treatment of low-risk gestational trophoblastic neoplasia: a clinical randomized trial. Int J Gynecol Cancer 26:5 (2016), 971–976.
Bolze, P.A., Mathe, M., Hajri, T., You, B., Dabi, Y., Schott, A.M., et al. First-line hysterectomy for women with low-risk non-metastatic gestational trophoblastic neoplasia no longer wishing to conceive. Gynecol Oncol 150:2 (2018), 282–287.
Ahamed, E., Short, D., North, B., Savage, P.M., Seckl, M.J., Survival of women with gestational trophoblastic neoplasia and liver metastases: is it improving?. J Reprod Med 57:5–6 (2012), 262–269.
Alifrangis, C., Agarwal, R., Short, D., Fisher, R.A., Sebire, N.J., Harvey, R., et al. EMA/CO for high-risk gestational trophoblastic neoplasia: good outcomes with induction low-dose etoposide-cisplatin and genetic analysis. J Clin Oncol 31:2 (2013), 280–286.
Balachandran, K., Salawu, A., Ghorani, E., Kaur, B., Sebire, N.J., Short, D., et al. When to stop human chorionic gonadotrophin (hCG) surveillance after treatment with chemotherapy for gestational trophoblastic neoplasia (GTN): a national analysis on over 4,000 patients. Gynecol Oncol, 2019.
Frijstein, M.M., Lok, C.A.R., Short, D., Singh, K., Fisher, R.A., Hancock, B.W., et al. The results of treatment with high-dose chemotherapy and peripheral blood stem cell support for gestational trophoblastic neoplasia. Eur J Cancer 109 (2019), 162–171.
Froeling, F.E.M., Ramaswami, R., Papanastasopoulos, P., Kaur, B., Sebire, N.J., Short, D., et al. Intensified therapies improve survival and identification of novel prognostic factors for placental-site and epithelioid trophoblastic tumours. Br J Cancer 120:6 (2019), 587–594.
Ghorani, E., Kaur, B., Fisher, R.A., Short, D., Joneborg, U., Carlson, J.W., et al. Pembrolizumab is effective for drug-resistant gestational trophoblastic neoplasia. Lancet 390:10110 (2017), 2343–2345.
Frijstein, M.M., Lok, C.A.R., Coulter, J., van Trommel, N.E., Ten Kate-Booij, M.J., Golfier, F., et al. Is there uniformity in definitions and treatment of gestational trophoblastic disease in Europe?. Int J Gynecol Cancer 29:1 (2019), 108–112.
Bolze, P.A., Attia, J., Massardier, J., Seckl, M.J., Massuger, L., van Trommel, N., et al. Formalised consensus of the European Organisation for Treatment of Trophoblastic Diseases on management of gestational trophoblastic diseases. Eur J Cancer 51:13 (2015), 1725–1731.
