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1. Matsui H, Suzuka K, Iitsuka Y, Yamazawa K, Tanaka N, Mitsuhashi A, Seki K, Sekiya S: Salvage combination chemotherapy with 5-fluorouracil and actinomycin D for patients with refractory, high-risk gestational trophoblastic tumors. Cancer; 2002 Sep 1;95(5):1051-4
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Salvage combination chemotherapy with 5-fluorouracil and actinomycin D for patients with refractory, high-risk gestational trophoblastic tumors.
  • BACKGROUND: The objective of this study was to evaluate the efficacy and toxicity of a high-dose 5-fluorouracil and actinomycin D regimen (the FA regimen) as salvage chemotherapy for patients with high-risk gestational trophoblastic tumors (GTTs).
  • Of those 10 patients, 7 patients developed drug resistance to methotrexate, etoposide, and actinomycin D combination chemotherapy (the MEA regimen); 1 patient developed recurrent disease after receiving the MEA regimen; and 2 patients developed recurrent disease after receiving combination chemotherapy with etoposide, methotrexate, and actinomycin D alternating with cyclophosphamide and vincristine (the EMA/CO regimen).
  • The hematologic toxicity of the FA regimen was graded at every chemotherapy course.
  • Two patients died due to multidrug resistance, and two patients subsequently developed recurrent disease.
  • The two patients with recurrent disease were successfully salvaged again with the MEA regimen.
  • CONCLUSIONS: Although etoposide-containing chemotherapy is currently the most effective and well-tolerated regimen for patients with high-risk GTTs, 20-30% of patients develop resistance to etoposide-containing regimens.
  • Salvage combination chemotherapy with FA is effective for these patients with refractory disease, and the toxicity is predictable and manageable.
  • [MeSH-major] Neoplasm Recurrence, Local / drug therapy. Trophoblastic Neoplasms / drug therapy. Uterine Neoplasms / drug therapy
  • [MeSH-minor] Adult. Dactinomycin / administration & dosage. Drug Resistance, Multiple. Female. Fluorouracil / administration & dosage. Humans. Leukopenia / chemically induced. Pregnancy. Retrospective Studies. Risk Factors. Salvage Therapy. Survival Analysis. Thrombocytopenia / chemically induced

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  • [Copyright] Copyright 2002 American Cancer Society.
  • (PMID = 12209690.001).
  • [ISSN] 0008-543X
  • [Journal-full-title] Cancer
  • [ISO-abbreviation] Cancer
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 1CC1JFE158 / Dactinomycin; U3P01618RT / Fluorouracil
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2. Yang JJ, Xiang Y, Wan XR, Shi JR, Wei SM, Yang XY: [Management and risk factors of recurrent gestational trophoblastic tumor]. Zhonghua Yi Xue Za Zhi; 2006 Jan 3;86(1):52-5

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  • [Title] [Management and risk factors of recurrent gestational trophoblastic tumor].
  • OBJECTIVE: To analyze the management, prognosis and prognostic risk factors of recurrent gestational trophoblastic tumor (GTT).
  • METHODS: One thousand one hundred and thirty GTT patients, aged 29 +/- 6, were hospitalized and treated and 901 of them got complete remission (CR).
  • Among these CR patients, 31 suffered relapsed.
  • RESULTS: Thirty-one patients suffered 15.3 months (6-72 months) after the cessation of treatment with an overall recurrence rate of 3.4% (31/901).
  • Four of the 31 patients suffered relapse repeatedly (totally seven times), resulting in an overall re-recurrence rate of 22.6% (7/31).
  • Twenty-five of the 31 patients were re-hospitalized and received treatment.
  • Eighteen of them got complete remission (CR), 3 got partial remission (PR), and 4 died of progress of the disease (PD).
  • The major adverse prognostic risk factors included: clinical stage (P < 0.05), an interval of more than 12 months from the antecedent pregnancy to chemotherapy (OR = 3.170, P < 0.05), declination of beta-hCG level back to normal titer after more than seven courses of chemotherapy (OR = 4.775, P < 0.05), and less than two courses of consolidation chemotherapy (OR = 0.441, P < 0.05).
  • CONCLUSION: More attention should be given to those GTT patients with adverse prognostic risk factors.
  • Multi-drug and multiple route chemotherapy and/or combined surgical intervention can be used to improve the cure rate and lower the re-recurrence rate of the GTT recurrent patients.
  • [MeSH-major] Gestational Trophoblastic Disease / therapy. Neoplasm Recurrence, Local / therapy
  • [MeSH-minor] Adult. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Combined Modality Therapy. Disease Progression. Female. Humans. Middle Aged. Neoplasm Staging. Pregnancy. Prognosis. Remission Induction. Retrospective Studies. Risk Factors

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  • (PMID = 16606539.001).
  • [ISSN] 0376-2491
  • [Journal-full-title] Zhonghua yi xue za zhi
  • [ISO-abbreviation] Zhonghua Yi Xue Za Zhi
  • [Language] chi
  • [Publication-type] English Abstract; Journal Article
  • [Publication-country] China
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3. Yang J, Xiang Y, Wan X, Yang X: Recurrent gestational trophoblastic tumor: management and risk factors for recurrence. Gynecol Oncol; 2006 Nov;103(2):587-90
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  • [Title] Recurrent gestational trophoblastic tumor: management and risk factors for recurrence.
  • OBJECTIVE: To analyze retrospectively the management of recurrent gestational trophoblastic tumor (GTT) patients and evaluate the recurrence associated risk factors.
  • METHOD: 901 gestational trophoblastic tumor (GTT) patients who received treatment at Peking Union Medical College Hospital from January 1985 to January 2004 achieved complete remission (CR).
  • Among them, thirty-one (31/901) relapsed later.
  • RESULTS: In all 31 patients, recurrences occurred 6 to 72 months (15.3 months on average) after completing treatment.
  • Of the 25 patients who received treatment again in our hospital, 21 achieved CR, 3 achieved partial remission (PR), and 1 died of progression of disease (PD).
  • Among the 21 CR patients, 4 relapsed repeatedly.
  • The four recurrence associated risk factors identified by multivariate analysis were clinical stage (P<0.05), an interval of more than 12 months between the end of antecedent pregnancy and the start of chemotherapy (odds ratio=3.170, P<0.05), a negative blood beta-hCG titer after seven courses of chemotherapy (odds ratio=4.475, P<0.05), and a less than two courses of consolidation chemotherapy (odds ratio=0.441, P<0.05).
  • CONCLUSION: More attention should be given to GTT patients with recurrence associated risk factors.
  • Combination therapy for GTT treatment is effective.
  • These factors may need to be integrated into treatment algorithms.
  • [MeSH-major] Gestational Trophoblastic Disease / drug therapy. Gestational Trophoblastic Disease / surgery
  • [MeSH-minor] Adult. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Chorionic Gonadotropin, beta Subunit, Human / blood. Dactinomycin / administration & dosage. Etoposide / administration & dosage. Female. Fluorouracil / administration & dosage. Fluorouracil / therapeutic use. Humans. Methotrexate / administration & dosage. Middle Aged. Neoplasm Recurrence, Local / blood. Neoplasm Recurrence, Local / drug therapy. Neoplasm Recurrence, Local / pathology. Neoplasm Recurrence, Local / surgery. Neoplasm Staging. Pregnancy. Retrospective Studies. Risk Factors. Vincristine / administration & dosage

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  • (PMID = 16750258.001).
  • [ISSN] 0090-8258
  • [Journal-full-title] Gynecologic oncology
  • [ISO-abbreviation] Gynecol. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Chorionic Gonadotropin, beta Subunit, Human; 1CC1JFE158 / Dactinomycin; 5J49Q6B70F / Vincristine; 6PLQ3CP4P3 / Etoposide; U3P01618RT / Fluorouracil; YL5FZ2Y5U1 / Methotrexate
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4. Rahaman J, Steiner N, Hayes MP, Chuang L, Fishman D, Gretz Iii H: Chemotherapy for gynecologic cancers. Mt Sinai J Med; 2009 Dec;76(6):577-88

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  • [Title] Chemotherapy for gynecologic cancers.
  • This review highlights significant recent developments and trends in chemotherapy for major gynecologic malignancies, i.e., ovarian cancer, endometrial cancer, uterine sarcomas, gestational trophoblastic neoplasia, and cervical cancer.
  • In ovarian cancer, chemotherapeutic options for early, advanced and recurrent disease are in the adjuvant setting as well as in the neoadjuvant setting are explored.
  • For uterine cancer, adjuvant chemotherapy is employed for high risk epithelial subtypes with early disease, such as uterine papillary serous carcinomas, uterine carcinosarcomas and leiomyosarcomas, advanced stage cases, as well as recurrent disease.
  • The review then proceeds to further discuss the appropriate treatment based on the International Federation of Gynecology and Obstetrics prognostic scoring system for gestational trophoblastic neoplasia.
  • Finally, chemotherapy is utilized in cervical cancer as neo-adjuvant therapy prior to surgery or radiation, as a sensitizer concomitantly with radiation therapy or for the treatment of advanced and recurrent disease.
  • [MeSH-major] Antineoplastic Agents / administration & dosage. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Genital Neoplasms, Female / drug therapy
  • [MeSH-minor] Combined Modality Therapy. Drug Resistance, Neoplasm. Female. Humans. Neoplasm Recurrence, Local / drug therapy. Neoplasm Recurrence, Local / pathology. Neoplasm Staging. Prognosis

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  • [Copyright] Copyright 2009 Mount Sinai School of Medicine.
  • (PMID = 20014427.001).
  • [ISSN] 1931-7581
  • [Journal-full-title] The Mount Sinai journal of medicine, New York
  • [ISO-abbreviation] Mt. Sinai J. Med.
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antineoplastic Agents
  • [Number-of-references] 75
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5. Kerkmeijer LG, Wielsma S, Massuger LF, Sweep FC, Thomas CM: Recurrent gestational trophoblastic disease after hCG normalization following hydatidiform mole in The Netherlands. Gynecol Oncol; 2007 Jul;106(1):142-6
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  • [Title] Recurrent gestational trophoblastic disease after hCG normalization following hydatidiform mole in The Netherlands.
  • OBJECTIVES: To determine the risk for recurrent trophoblastic disease after spontaneous normalization of human chorionic gonadotropin (hCG) levels in patients with hydatidiform mole and to determine the risk for tumor relapse after apparent remission following chemotherapy in patients with low- and high-risk persistent trophoblastic disease.
  • Of the 265 patients, one patient (0.38%) subsequently required chemotherapeutic treatment for recurrent trophoblastic disease (95% confidence interval 0.0% to 2.1%).
  • In contrary, in order to assure sustained remission, the relapse rates after chemotherapy in the current study emphasize the need for surveillance of trophoblastic tumor patients even after complete remission has apparently been achieved.
  • [MeSH-major] Chorionic Gonadotropin, beta Subunit, Human / blood. Hydatidiform Mole / blood. Neoplasm Recurrence, Local / blood. Trophoblastic Neoplasms / blood. Uterine Neoplasms / blood

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  • (PMID = 17462723.001).
  • [ISSN] 0090-8258
  • [Journal-full-title] Gynecologic oncology
  • [ISO-abbreviation] Gynecol. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Chorionic Gonadotropin, beta Subunit, Human
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6. Kunz J, Bannwart F: [Placental site trophoblastic tumor: case report and review of literature]. Praxis (Bern 1994); 2008 Apr 2;97(7):387-94
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  • [Title] [Placental site trophoblastic tumor: case report and review of literature].
  • [Transliterated title] Placental site trophoblastic tumor--Ein Fallbericht und Literatur├╝bersicht.
  • Histology revealed a placental site trophoblastic tumour (PSTT).
  • This is a rare tumour with malignant potential, whose prognosis depends on the stage of the primary tumour, the period of time between the last pregnancy and onset of disease, the patient's age, and the rate of mitosis, and whose progress cannot be assessed using the WHO Prognostic Index Score for Gestational Trophoblastic Disease.
  • In therapeutic terms, hysterectomy is recommended.
  • Chemosensitivity is low and, due to the infrequency of the tumours, the most suitable chemotherapy scheme is unknown.
  • In the case of metastasising or recurrent PSTT, the EP/EMA regime has proved to be most effective.
  • [MeSH-major] Cesarean Section. Endosonography. Gestational Trophoblastic Disease / ultrasonography. Placenta Diseases / ultrasonography. Postoperative Complications / ultrasonography. Uterine Neoplasms / ultrasonography
  • [MeSH-minor] Adult. Biomarkers, Tumor / analysis. Cervix Uteri / pathology. Female. Humans. Hysterectomy. Inhibins / analysis. Neoplasm Staging. Pancreatin / analysis. Pregnancy. Reoperation. Uterine Rupture / surgery. Uterus / pathology

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  • (PMID = 18548819.001).
  • [ISSN] 1661-8157
  • [Journal-full-title] Praxis
  • [ISO-abbreviation] Praxis (Bern 1994)
  • [Language] ger
  • [Publication-type] Case Reports; English Abstract; Journal Article
  • [Publication-country] Switzerland
  • [Chemical-registry-number] 0 / Biomarkers, Tumor; 57285-09-3 / Inhibins; 8049-47-6 / Pancreatin
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7. Sasaki S, Sasaki Y, Iino K: Recurrent gestational trophoblastic disease in a case of suspected quiescent gestational trophoblastic disease: a case report. J Reprod Med; 2010 Jul-Aug;55(7-8):317-20
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  • [Title] Recurrent gestational trophoblastic disease in a case of suspected quiescent gestational trophoblastic disease: a case report.
  • BACKGROUND: In Japan there are no reported cases of phantom human chorionic gonadotropin (hCG) or quiescent gestational trophoblastic disease (GTD).
  • GTD is managed well in Japan according to Japanese guidelines for the treatment of GTD, and we have almost conquered this disease during recent decades.
  • After careful evaluation, including measurement of hyperglycosylated hCG, we concluded that this case was not a quiescent GTD but recurrent GTD.
  • Three years and 3 months later beta-hCG went up to 3.1 ng/mL, but magnetic resonance imaging and computed tomography scans did not show any evidence of tumor.
  • CONCLUSION: After thorough evaluation we concluded that this case was not a quiescent GTD but a recurrent GTD.
  • We emphasize that sufficient initial chemotherapy is very important to reduce the risk of recurrence.
  • [MeSH-minor] Antineoplastic Agents / therapeutic use. Chorionic Gonadotropin / blood. Dilatation and Curettage. Etoposide / therapeutic use. Female. Humans. Methotrexate / therapeutic use. Middle Aged. Pregnancy

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  • (PMID = 20795345.001).
  • [ISSN] 0024-7758
  • [Journal-full-title] The Journal of reproductive medicine
  • [ISO-abbreviation] J Reprod Med
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antineoplastic Agents; 0 / Chorionic Gonadotropin; 6PLQ3CP4P3 / Etoposide; YL5FZ2Y5U1 / Methotrexate
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8. Jiang J, Nan FF, Yang XS, Zhang YZ, Wang B, Kong BH: [Combination chemotherapy with etoposide and cisplatin for high-risk, chemorefractory and recurrent gestational trophoblastic neoplasia]. Zhonghua Fu Chan Ke Za Zhi; 2007 Sep;42(9):595-9
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  • [Title] [Combination chemotherapy with etoposide and cisplatin for high-risk, chemorefractory and recurrent gestational trophoblastic neoplasia].
  • OBJECTIVE: To evaluate the feasibility and effectiveness of combination chemotherapy with etoposide and cisplatin (EP) regimen on the patients with high-risk, chemorefractory and recurrent gestational trophoblastic neoplasia (GTN).
  • METHODS: Thirty-nine patients with gestational trophoblastic tumors were analyzed retrospectively, 25 of 39 patients were of high-risk, 9 patients were chemorefractory and 5 patients were recurrent.
  • Nineteen patients achieved complete remission and 6 patients showed drug-resistant.
  • Six patients achieved complete remission and 3 patients showed drug-resistant again.
  • Five patients with recurrent GTN received 27 cycles and the average number of courses was 5.4.
  • Four patients achieved complete remission, 1 patient showed drug-resistance and died.
  • None of the women developed secondary tumors.
  • CONCLUSION: The EP regimen is effective and safe for the treatment of high-risk, chemorefractory and recurrent GTN.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Gestational Trophoblastic Disease / drug therapy. Neoplasm Recurrence, Local / drug therapy. Uterine Neoplasms / drug therapy
  • [MeSH-minor] Adult. Chorionic Gonadotropin / blood. Cisplatin / administration & dosage. Cisplatin / adverse effects. Drug Resistance, Neoplasm. Etoposide / administration & dosage. Etoposide / adverse effects. Female. Follow-Up Studies. Humans. Leukopenia / chemically induced. Middle Aged. Neoplasm Staging. Pregnancy. Pregnancy Outcome. Retrospective Studies. Treatment Outcome. Vomiting / chemically induced. Young Adult

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  • (PMID = 17983513.001).
  • [ISSN] 0529-567X
  • [Journal-full-title] Zhonghua fu chan ke za zhi
  • [ISO-abbreviation] Zhonghua Fu Chan Ke Za Zhi
  • [Language] chi
  • [Publication-type] English Abstract; Journal Article
  • [Publication-country] China
  • [Chemical-registry-number] 0 / Chorionic Gonadotropin; 6PLQ3CP4P3 / Etoposide; Q20Q21Q62J / Cisplatin
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9. Randall TC, Coukos G, Wheeler JE, Rubin SC: Prolonged remission of recurrent, metastatic placental site trophoblastic tumor after chemotherapy. Gynecol Oncol; 2000 Jan;76(1):115-7
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  • [Title] Prolonged remission of recurrent, metastatic placental site trophoblastic tumor after chemotherapy.
  • BACKGROUND: Placental site trophoblastic tumor (PSTT) is a form of gestational trophoblastic neoplasm that is frequently resistant to chemotherapy.
  • In most cases disease is confined to the uterus and can be cured by curettage or simple hysterectomy.
  • Patients with metastases, however, frequently have progression of disease and die despite aggressive multiagent chemotherapy.
  • Hysterectomy and staging surgery revealed a large tumor in the endometrial cavity and multiple metastases.
  • Three years after completion of the second regimen she is without evidence of disease.
  • CONCLUSION: Treatment with multiagent chemotherapy can produce long-term remission, even in patients with recurrent, metastatic PSTT.
  • Addition of platinum may be helpful in patients who have recurred or progressed after treatment with non-platinum-containing regimens.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Trophoblastic Tumor, Placental Site / drug therapy. Uterine Neoplasms / drug therapy
  • [MeSH-minor] Adult. Disease Progression. Female. Humans. Neoplasm Metastasis / drug therapy. Neoplasm Recurrence, Local / drug therapy. Pregnancy. Prognosis. Treatment Outcome

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  • [Copyright] Copyright 2000 Academic Press.
  • (PMID = 10620452.001).
  • [ISSN] 0090-8258
  • [Journal-full-title] Gynecologic oncology
  • [ISO-abbreviation] Gynecol. Oncol.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] UNITED STATES
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10. Rodriguez N, Goldstein DP, Berkowitz RS: Treating gestational trophoblastic disease. Expert Opin Pharmacother; 2010 Dec;11(18):3027-39
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  • [Title] Treating gestational trophoblastic disease.
  • IMPORTANCE OF THE FIELD: Gestational trophoblastic disease is one of the few human malignancies that is curable, even in advanced stages of the disease.
  • However, appropriate management and follow-up are essential components in curing this disease.
  • AREAS COVERED IN THIS REVIEW: Observational, retrospective and prospective studies evaluating the efficacy of medical and surgical management of gestational trophoblastic disease were analyzed to provide a comprehensive review of current and new treatment modalities.
  • WHAT THE READER WILL GAIN: The reader will obtain information on how to classify gestational trophoblastic neoplasia (GTN) into low- and high-risk groups, as well as learn the medical and surgical management of low- and high-risk GTN and recurrent GTN.
  • The effectiveness of treatment regimens and subsequent fertility is also reviewed.
  • TAKE HOME MESSAGE: GTN is highly responsive to chemotherapy.
  • Even in advanced-stage or recurrent disease, cure can be achieved and fertility preserved.
  • [MeSH-major] Antineoplastic Agents / therapeutic use. Fertility. Gestational Trophoblastic Disease / therapy
  • [MeSH-minor] Female. Humans. Neoplasm Recurrence, Local. Neoplasm Staging. Pregnancy. Risk Factors. Salvage Therapy / methods. Treatment Outcome

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  • (PMID = 20958110.001).
  • [ISSN] 1744-7666
  • [Journal-full-title] Expert opinion on pharmacotherapy
  • [ISO-abbreviation] Expert Opin Pharmacother
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Antineoplastic Agents
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11. Shih IeM: Gestational trophoblastic neoplasia--pathogenesis and potential therapeutic targets. Lancet Oncol; 2007 Jul;8(7):642-50
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  • [Title] Gestational trophoblastic neoplasia--pathogenesis and potential therapeutic targets.
  • Gestational trophoblastic neoplasia comprises a unique group of human neoplastic diseases that derive from fetal trophoblastic tissues and represent semiallografts in patients.
  • This group is composed of choriocarcinoma, placental-site trophoblastic tumour, and epithelioid trophoblastic tumour, and many forms are derived from the precursor lesions, hydatidiform moles.
  • Although most patients with gestational trophoblastic neoplasia are cured by chemotherapy and tumour resection, some patients suffer from metastatic diseases that are refractory to conventional chemotherapy.
  • Therefore, new therapeutic regimens are needed to reduce the toxic effects associated with current chemotherapy and to salvage the occasional non-operable patients with recurrent and chemoresistant disease.
  • Until the fundamental biology of gestational trophoblastic neoplasia becomes more clearly understood, development of a new treatment will remain empirical.
  • This review will briefly summarise the recent advances in understanding the molecular aetiology of this group of diseases and highlight the molecules that can be potentially used for therapeutic targets to treat metastatic gestational trophoblastic neoplasia.
  • [MeSH-major] Gestational Trophoblastic Disease / therapy
  • [MeSH-minor] Biomarkers, Tumor / antagonists & inhibitors. Biomarkers, Tumor / metabolism. Female. Humans. Neoplasm Proteins / antagonists & inhibitors. Neoplasm Proteins / metabolism. Pregnancy

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  • (PMID = 17613426.001).
  • [ISSN] 1470-2045
  • [Journal-full-title] The Lancet. Oncology
  • [ISO-abbreviation] Lancet Oncol.
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Biomarkers, Tumor; 0 / Neoplasm Proteins
  • [Number-of-references] 74
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12. Jain KA: Gestational trophoblastic disease: pictorial review. Ultrasound Q; 2005 Dec;21(4):245-53
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  • [Title] Gestational trophoblastic disease: pictorial review.
  • When the sonographic appearance is correlated with the clinical presentation, accurate diagnosis is possible in most cases of gestational trophoblastic disease (GTD).
  • Sonography and Doppler imaging are helpful in diagnosing gestational trophoblastic disease, in determining whether invasive disease is present, in detecting recurrent disease, and in following the effectiveness of chemotherapy.
  • This pictorial essay describes the pathogenesis, epidemiology, and sonographic spectrum of gestational trophoblastic disease.
  • [MeSH-major] Gestational Trophoblastic Disease / ultrasonography. Pregnancy Complications, Neoplastic / ultrasonography. Pregnancy Outcome. Ultrasonography, Doppler, Color
  • [MeSH-minor] Adult. Choriocarcinoma / physiopathology. Choriocarcinoma / ultrasonography. Education, Medical, Continuing. Female. Humans. Hydatidiform Mole / physiopathology. Hydatidiform Mole / ultrasonography. Middle Aged. Neoplasm Staging. Pregnancy. Sensitivity and Specificity. Severity of Illness Index

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  • (PMID = 16344728.001).
  • [ISSN] 0894-8771
  • [Journal-full-title] Ultrasound quarterly
  • [ISO-abbreviation] Ultrasound Q
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 41
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13. Newlands ES: The management of recurrent and drug-resistant gestational trophoblastic neoplasia (GTN). Best Pract Res Clin Obstet Gynaecol; 2003 Dec;17(6):905-23

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] The management of recurrent and drug-resistant gestational trophoblastic neoplasia (GTN).
  • Gestational trophoblastic neoplasia (GTN) comprises a spectrum of disease from low-risk disease which can be cured with simple relatively non-toxic treatment, to extremely aggressive tumours which require specialized management.
  • The prognostic variables in patients with GTN are different from those in other gynaecological malignancies, and the major adverse prognostic variables include long interval from antecedent pregnancy, high concentrations of the pregnancy hormone, human chorionic gonadotrophin, metastases in brain and liver and failure of prior treatment.
  • Patients who relapse after their prior treatment can also be categorized into different risk groups.
  • Salvage treatment can vary from single agent actinomycin D to combination chemotherapy and, in selected cases, surgery.
  • The late side-effects of more intensive treatment are a small risk of inducing second tumours and also of bringing forward the age of menopause.
  • [MeSH-major] Gestational Trophoblastic Disease / drug therapy. Neoplasm Recurrence, Local / drug therapy
  • [MeSH-minor] Antineoplastic Agents / adverse effects. Central Nervous System Neoplasms / secondary. Chorionic Gonadotropin / blood. Drug Resistance, Neoplasm. Female. Humans. Neoplasm Staging. Pregnancy. Prognosis. Risk Factors. Treatment Outcome. Trophoblastic Tumor, Placental Site / therapy. Uterine Neoplasms / therapy

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  • (PMID = 14614889.001).
  • [ISSN] 1521-6934
  • [Journal-full-title] Best practice & research. Clinical obstetrics & gynaecology
  • [ISO-abbreviation] Best Pract Res Clin Obstet Gynaecol
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Antineoplastic Agents; 0 / Chorionic Gonadotropin
  • [Number-of-references] 28
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14. Cao Y, Xiang Y, Feng F, Wan X, Yang X: Surgical resection in the management of pulmonary metastatic disease of gestational trophoblastic neoplasia. Int J Gynecol Cancer; 2009 May;19(4):798-801
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  • [Title] Surgical resection in the management of pulmonary metastatic disease of gestational trophoblastic neoplasia.
  • The objective of this study was to evaluate the influence of surgical resection on survival outcome in patients with gestational trophoblastic neoplasia with pulmonary metastatic disease.
  • Medical records of 62 patients with gestational trophoblastic neoplasia who underwent pulmonary lobectomy or limited resection were reviewed.
  • The cases were divided into 3 groups, namely, the recurrent group (group A), the drug-resistant group (group B), and the group with satisfactory response to chemotherapy but with residual pulmonary lesion (group C).
  • By comparing treatment failure cases with patients who achieved complete remission, factors that might affect the clinical outcome of pulmonary surgery were also analyzed.
  • Patients who have received more than 4 regimens or 13 courses of preoperative chemotherapy seemed to have unfavorable prognosis (P < 0.05).
  • Follow-ups could be carried out without surgical resection for patients with satisfactory response to chemotherapy but with residual pulmonary lesions.
  • Pulmonary surgery is indicated when clinical evidence suggests that pulmonary metastatic disease causes relapse or drug-resistance and the lesions are relatively localized.
  • However, surgery is not advisable for patients who received more than 4 regimens or 13 courses of preoperative chemotherapy.
  • [MeSH-major] Gestational Trophoblastic Disease / surgery. Lung Neoplasms / secondary. Lung Neoplasms / surgery
  • [MeSH-minor] Adult. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Combined Modality Therapy. Dactinomycin / administration & dosage. Drug Resistance, Neoplasm. Etoposide / administration & dosage. Female. Fluorouracil / administration & dosage. Humans. Methotrexate / administration & dosage. Middle Aged. Neoplasm Staging. Pregnancy. Vincristine / administration & dosage. Young Adult

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  • (PMID = 19509591.001).
  • [ISSN] 1525-1438
  • [Journal-full-title] International journal of gynecological cancer : official journal of the International Gynecological Cancer Society
  • [ISO-abbreviation] Int. J. Gynecol. Cancer
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 1CC1JFE158 / Dactinomycin; 5J49Q6B70F / Vincristine; 6PLQ3CP4P3 / Etoposide; U3P01618RT / Fluorouracil; YL5FZ2Y5U1 / Methotrexate
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15. Yang JJ, Xiang Y, Wan XR, Li JG, Yang XY: [Outcome of gestational trophoblastic neoplasia patients with residual lung tumor after completion of treatment]. Zhonghua Fu Chan Ke Za Zhi; 2007 Jan;42(1):26-8
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  • [Title] [Outcome of gestational trophoblastic neoplasia patients with residual lung tumor after completion of treatment].
  • OBJECTIVE: To analyze retrospectively the prognosis of gestational trophoblastic neoplasia (GTN) patients who achieved normal human chorionic gonadotropin-beta subunit (beta-hCG) titer after completing treatment but remained with residual lung tumor.
  • Among these patients, 901 achieved complete remission (CR); 152 achieved normal blood beta-hCG titer after the completion of treatment but remained with residual lung tumor (defined as partial remission).
  • Statistical analysis was used to compare the recurrent rate of the CR patients with the progression rate of the 152 patients.
  • RESULTS: The blood beta-hCG level of all the 152 patients returned to normal after they received 1-30 courses of standard multiple-drug combined chemotherapy treatment.
  • Another 0-8 courses of chemotherapy were applied to these patients before they left hospital.
  • Of the rest 135 patients followed up for 14 to 110 months, 83 showed no significant changes in terms of their residual tumors; the residual tumors in 46 patients diminished or disappeared; and the other 6 patients had progression of disease (PD), with beta-hCG levels going up 6-8 months after completing treatment (increased lung metastases were observed in four of the six patients).
  • There was no significant difference (P > 0.05) between the recurrent rate [3.4% (31/901)] of the 901 CR patients and the progression rate [3.9% (6/152)] of the 152 patients.
  • There was also no significant difference (P > 0.05) between the recurrent rate [2.2% (10/463)] of the CR patients with lung metastasis and the progression rate of the 152 patients.
  • CONCLUSIONS: After normalization of beta-hCG titer, patients whose lung tumors remained unchanged even after several additional courses of chemotherapy should be considered as CR patients.
  • Follow-ups should be strictly carried out on these patients, especially at around 6 months after the completion of treatment, and particularly for high-risk and drug-resistant choriocarcinoma patients.
  • [MeSH-major] Gestational Trophoblastic Disease / pathology. Lung Neoplasms / secondary
  • [MeSH-minor] Adult. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Chorionic Gonadotropin, beta Subunit, Human / blood. Female. Fluorouracil / administration & dosage. Humans. Methotrexate / administration & dosage. Middle Aged. Neoplasm Recurrence, Local / pathology. Neoplasm Staging. Neoplasm, Residual. Pregnancy. Prognosis. Retrospective Studies

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  • (PMID = 17331417.001).
  • [ISSN] 0529-567X
  • [Journal-full-title] Zhonghua fu chan ke za zhi
  • [ISO-abbreviation] Zhonghua Fu Chan Ke Za Zhi
  • [Language] chi
  • [Publication-type] Comparative Study; English Abstract; Journal Article
  • [Publication-country] China
  • [Chemical-registry-number] 0 / Chorionic Gonadotropin, beta Subunit, Human; U3P01618RT / Fluorouracil; YL5FZ2Y5U1 / Methotrexate
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16. Osborne R, Covens A, Mirchandani D, Gerulath A: Successful salvage of relapsed high-risk gestational trophoblastic neoplasia patients using a novel paclitaxel-containing doublet. J Reprod Med; 2004 Aug;49(8):655-61
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  • [Title] Successful salvage of relapsed high-risk gestational trophoblastic neoplasia patients using a novel paclitaxel-containing doublet.
  • OBJECTIVE: To describe one institution's results with a novel 3-drug doublet, consisting of paclitaxel, etoposide and cisplatin, for salvage of relapsed high-risk gestational trophoblastic neoplasia (GTN) patients.
  • STUDY DESIGN: Analysis of treatment results with the doublet regimen in two patients with recurrent/persistent high-risk choriocarcinoma in the Division of Gynecologic Oncology, Toronto-Sunnybrook Regional Cancer Centre, University of Toronto.
  • Both patients had been treated previously with one or more of the doublet drugs.
  • Patient 1 required surgical resection of a single focus of recurrence and was again in complete remission 27 months after completing her last course of doublet chemotherapy.
  • Patient 2 has not relapsed since completing the treatment.
  • CONCLUSION: The doublet regimen appears capable of producing a sustained response in patients with recurrent high-risk GTN who have previously undergone extensive chemotherapy.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Choriocarcinoma / drug therapy. Choriocarcinoma / pathology. Gestational Trophoblastic Disease / drug therapy. Gestational Trophoblastic Disease / pathology. Neoplasm Recurrence, Local / drug therapy. Uterine Neoplasms / drug therapy. Uterine Neoplasms / pathology
  • [MeSH-minor] Adult. Cisplatin / administration & dosage. Etoposide / administration & dosage. Female. Humans. Paclitaxel / administration & dosage. Pregnancy. Salvage Therapy

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  • [ErratumIn] J Reprod Med. 2005 May;50(5):376. Merchandani, DE [corrected to Mirchandani, D]
  • (PMID = 15457856.001).
  • [ISSN] 0024-7758
  • [Journal-full-title] The Journal of reproductive medicine
  • [ISO-abbreviation] J Reprod Med
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 6PLQ3CP4P3 / Etoposide; P88XT4IS4D / Paclitaxel; Q20Q21Q62J / Cisplatin
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17. Cao Y, Xiang Y, Feng FZ, Wan XR, Yang XY: [Pulmonary resection in the management of gestational trophoblastic neoplasia: a clinical study]. Zhonghua Fu Chan Ke Za Zhi; 2008 Dec;43(12):928-30
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  • [Title] [Pulmonary resection in the management of gestational trophoblastic neoplasia: a clinical study].
  • OBJECTIVE: To investigate the effect of surgical resection in the management of gestational trophoblastic neoplasia (GTN) patients with pulmonary metastases.
  • The cases were divided into recurrent group (group A, n = 10), drug-resistant group (group B, n = 28), and the group with satisfactory response to chemotherapy but residual pulmonary lesion (s) (group C, n = 25).
  • The patients' median age, antecedent pregnancy, International Federation of Gynecology and Obstetrics (FIGO) risk score, number of preoperative chemotherapy courses, preoperative beta-human chorionic gonadotrophin (beta-hCG) titer, lesion size, number of lobes affected, positive rate of histology, follow-ups and prognosis were compared between the three groups.
  • Positive histology of the resected specimen was more frequently recognized in recurrent and drug-resistant groups (A 60%, B 36%, C 12%).
  • In the drug-resistant group there were more preoperative chemotherapy sessions (A 3, B 7, C 5) and more patients with abnormal preoperative beta-hCG titer (A 50%, B 61%, C 12%).
  • CONCLUSIONS: Surgical resection is effective in the treatment of pulmonary metastases of GTN.
  • Surgery is indicated when clinical evidence suggests that pulmonary metastatic disease causes relapse or drug-resistance and the lesions are relatively localized.
  • Surgical resection is not recommended for patients with satisfactory response to chemotherapy but residual pulmonary lesions.
  • [MeSH-major] Gestational Trophoblastic Disease / surgery. Lung Neoplasms / surgery. Pneumonectomy
  • [MeSH-minor] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Chorionic Gonadotropin, beta Subunit, Human / blood. Combined Modality Therapy. Etoposide / administration & dosage. Female. Follow-Up Studies. Humans. Methotrexate / administration & dosage. Neoplasm Metastasis. Neoplasm Recurrence, Local. Neoplasm Staging. Pregnancy. Prognosis. Retrospective Studies

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  • (PMID = 19134333.001).
  • [ISSN] 0529-567X
  • [Journal-full-title] Zhonghua fu chan ke za zhi
  • [ISO-abbreviation] Zhonghua Fu Chan Ke Za Zhi
  • [Language] chi
  • [Publication-type] English Abstract; Journal Article
  • [Publication-country] China
  • [Chemical-registry-number] 0 / Chorionic Gonadotropin, beta Subunit, Human; 6PLQ3CP4P3 / Etoposide; YL5FZ2Y5U1 / Methotrexate
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18. Chang TC, Yen TC, Li YT, Wu YC, Chang YC, Ng KK, Jung SM, Wu TI, Lai CH: The role of 18F-fluorodeoxyglucose positron emission tomography in gestational trophoblastic tumours: a pilot study. Eur J Nucl Med Mol Imaging; 2006 Feb;33(2):156-63

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  • [Title] The role of 18F-fluorodeoxyglucose positron emission tomography in gestational trophoblastic tumours: a pilot study.
  • PURPOSE: We conducted a pilot trial to evaluate the value of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) in gestational trophoblastic tumours (GTTs).
  • METHODS: Patients with placental site trophoblastic tumour (PSTT), high-risk GTT (World Health Organisation score > or =8, disease onset at postpartum or greater than 6 months after antecedent pregnancy), metastatic GTT, recurrent/resistant GTT after chemotherapy, or post-molar GTT with unexplained abnormal beta-hCG regression and patients undergoing re-evaluation after salvage treatment were enrolled.
  • PET was undertaken within 1 week after computed tomography (CT).
  • Benefits of additional PET were seen in 7 of 16 (43.8%) scans; these benefits included disclosure of chemotherapy-resistant lesions (n = 2), exclusion of false-positive CT lesions (n = 1), detection of an additional lesion not found by conventional imaging (n = 1) in high-risk GTT at the start of primary chemotherapy, and confirmation of complete response to treatment for PSTT or to salvage therapy for recurrent/resistant GTT (n = 3).
  • CONCLUSION: Our preliminary results suggest that 18F-FDG PET is potentially useful in selected patients with GTT by providing precise mapping of metastases and tumour extent upfront, by monitoring treatment response and by localising viable tumours after chemotherapy.
  • A larger study is necessary to further define the role of 18F-FDG PET in GTT.
  • [MeSH-major] Fluorodeoxyglucose F18. Gestational Trophoblastic Disease / diagnosis. Positron-Emission Tomography / methods
  • [MeSH-minor] Adult. Antineoplastic Agents / pharmacology. Chorionic Gonadotropin, beta Subunit, Human / blood. Female. Humans. Image Processing, Computer-Assisted. Middle Aged. Neoplasm Metastasis. Pilot Projects. Pregnancy. Tomography, X-Ray Computed

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  • (PMID = 16220307.001).
  • [ISSN] 1619-7070
  • [Journal-full-title] European journal of nuclear medicine and molecular imaging
  • [ISO-abbreviation] Eur. J. Nucl. Med. Mol. Imaging
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] Germany
  • [Chemical-registry-number] 0 / Antineoplastic Agents; 0 / Chorionic Gonadotropin, beta Subunit, Human; 0Z5B2CJX4D / Fluorodeoxyglucose F18
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19. Shen DH, Khoo US, Ngan HY, Ng TY, Chau MT, Xue WC, Cheung AN: Coexisting epithelioid trophoblastic tumor and choriocarcinoma of the uterus following a chemoresistant hydatidiform mole. Arch Pathol Lab Med; 2003 Jul;127(7):e291-3
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  • [Title] Coexisting epithelioid trophoblastic tumor and choriocarcinoma of the uterus following a chemoresistant hydatidiform mole.
  • The epithelioid trophoblastic tumor is an unusual type of trophoblastic tumor.
  • Herein, we describe a patient with coexisting epithelioid trophoblastic tumor and choriocarcinoma in the uterus.
  • The patient had a history of hydatidiform mole with recurrent elevation of human chorionic gonadotrophin level that is resistant to chemotherapy.
  • Histopathologic and immunohistochemical examination showed distinctive differences between the 2 trophoblastic tumors.
  • The development of epithelioid trophoblastic tumor may be related to the persistence of locally invasive disease, which was unresponsive to chemotherapy.
  • The presence of an epithelioid trophoblastic tumor should be considered in chemoresistant gestational trophoblast tumor.
  • [MeSH-major] Choriocarcinoma. Chorionic Gonadotropin / blood. Drug Resistance, Neoplasm. Epithelioid Cells / pathology. Hydatidiform Mole / drug therapy. Trophoblastic Neoplasms. Uterine Neoplasms

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  • (PMID = 12823059.001).
  • [ISSN] 1543-2165
  • [Journal-full-title] Archives of pathology & laboratory medicine
  • [ISO-abbreviation] Arch. Pathol. Lab. Med.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Chorionic Gonadotropin
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20. Yang J, Xiang Y, Wan X, Yang X: The prognosis of gestational trophoblastic neoplasia patient with residual lung tumor after completing treatment. Gynecol Oncol; 2006 Nov;103(2):479-82
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] The prognosis of gestational trophoblastic neoplasia patient with residual lung tumor after completing treatment.
  • OBJECTIVE: To analyze retrospectively the prognosis of gestational trophoblastic neoplasia (GTN) patients who achieved normal beta-hCG titer after completing treatment but remained with residual lung tumor.
  • Among these patients, 901 achieved complete remission (CR); 152 achieved normal blood beta-hCG titer after the completion of treatment but remained with residual lung tumor (defined as partial remission).
  • Statistical analysis was used to compare the recurrent rate of the CR patients with the progression rate of the 152 patients.
  • Of the rest 135 patients followed up from 14 to 110 months, 83 showed no significant changes as to their residual tumors; 46 patients' residual tumors diminished or disappeared; and the other 6 patients got progression of disease (PD), with beta-hCG level going up 6-8 months after completing treatment.
  • There is no significant statistical difference (P > 0.05) between the recurrent rate of the 901 CR patients and the progression rate of the 152 patients.
  • There is also no significant statistical difference (P > 0.05) between the recurrent rate of the CR patients with lung metastasis and the progression rate of the 152 patients.
  • CONCLUSION: After achieving normal beta-hCG titer, patients whose lung tumor stayed unchanged even following several additional courses of chemotherapy should be considered as CR patients.
  • Follow-ups should be strictly carried out on these patients, especially at around 6 months after the completion of treatment, and particularly for high-risk and drug-resistant choriocarcinoma (CC) patients.
  • [MeSH-major] Gestational Trophoblastic Disease / pathology. Lung Neoplasms / secondary. Neoplasm Recurrence, Local / pathology
  • [MeSH-minor] Adult. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Chorionic Gonadotropin, beta Subunit, Human / blood. Disease Progression. Female. Humans. Middle Aged. Neoplasm Staging. Neoplasm, Residual. Pregnancy. Prognosis. Retrospective Studies

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  • (PMID = 16631244.001).
  • [ISSN] 0090-8258
  • [Journal-full-title] Gynecologic oncology
  • [ISO-abbreviation] Gynecol. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Chorionic Gonadotropin, beta Subunit, Human
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21. Schmid P, Nagai Y, Agarwal R, Hancock B, Savage PM, Sebire NJ, Lindsay I, Wells M, Fisher RA, Short D, Newlands ES, Wischnewsky MB, Seckl MJ: Prognostic markers and long-term outcome of placental-site trophoblastic tumours: a retrospective observational study. Lancet; 2009 Jul 4;374(9683):48-55
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  • [Title] Prognostic markers and long-term outcome of placental-site trophoblastic tumours: a retrospective observational study.
  • BACKGROUND: Placental-site trophoblastic tumours are a rare form of gestational trophoblastic disease and consequently information about optimum management or prognostic factors is restricted.
  • We aimed to assess the long-term outcome of stage-adapted management by surgery, chemotherapy, or both for patients with the disorder.
  • METHODS: 35 550 women were registered with gestational trophoblastic disease in the UK (1976-2006), of whom 62 were diagnosed with placental-site trophoblastic tumours and included, retrospectively, in the study.
  • Patients were treated by surgery, chemotherapy, or both.
  • We estimated the probabilities of overall survival and survival without recurrence of disease 5 and 10 years after the date of first treatment, and calculated the association of these endpoints with prognostic factors, including time since antecedent pregnancy, serum concentration of beta-human chorionic gonadotropin, and stage of disease, with both univariate and multivariate analyses.
  • FINDINGS: Probabilities of overall and recurrence-free survival 10 years after first treatment were 70% (95% CI 54-82) and 73% (54-85), respectively.
  • Patients with stage I disease had a 10-year probability of overall survival of 90% (77-100) and did not benefit from postoperative chemotherapy.
  • By contrast, patients with stage II, III, and IV disease required combined treatment with surgery and chemotherapy; probability of overall survival at 10 years was 52% (3-100) for patients with stage II disease and 49% (26-72) for stage III or IV disease.
  • Outcome for patients who had recurrent or refractory disease was poor: only four (22%) patients achieved long-term survival beyond 60 months.
  • Multivariate analysis showed that the only significant independent predictor of overall and recurrence-free survival was time since antecedent pregnancy.
  • INTERPRETATION: Stage-adapted management with surgery for stage I disease, and combined surgery and chemotherapy for stage II, III, and IV disease could improve the effectiveness of treatment for placental-site trophoblastic tumours.
  • Use of 48 months since antecedent pregnancy as a prognostic indicator of survival could help select patients for risk-adapted treatment.
  • [MeSH-major] Trophoblastic Tumor, Placental Site / diagnosis. Trophoblastic Tumor, Placental Site / therapy. Uterine Neoplasms / diagnosis. Uterine Neoplasms / therapy
  • [MeSH-minor] Adult. Analysis of Variance. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Biomarkers, Tumor / metabolism. Chorionic Gonadotropin / metabolism. Combined Modality Therapy. Cyclophosphamide / therapeutic use. Dactinomycin / therapeutic use. Etoposide / therapeutic use. Female. Great Britain / epidemiology. Humans. Hysterectomy. Kaplan-Meier Estimate. Methotrexate / therapeutic use. Neoplasm Recurrence, Local / epidemiology. Neoplasm Staging. Predictive Value of Tests. Pregnancy. Prognosis. Proportional Hazards Models. ROC Curve. Retrospective Studies. Survival Rate. Treatment Outcome. Vincristine / therapeutic use

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  • [CommentIn] Lancet. 2009 Jul 4;374(9683):6-7 [19552947.001]
  • (PMID = 19552948.001).
  • [ISSN] 1474-547X
  • [Journal-full-title] Lancet (London, England)
  • [ISO-abbreviation] Lancet
  • [Language] eng
  • [Grant] United Kingdom / Cancer Research UK / / ; United Kingdom / Department of Health / /
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Biomarkers, Tumor; 0 / Chorionic Gonadotropin; 1CC1JFE158 / Dactinomycin; 5J49Q6B70F / Vincristine; 6PLQ3CP4P3 / Etoposide; 8N3DW7272P / Cyclophosphamide; YL5FZ2Y5U1 / Methotrexate; EMA-CO protocol; MAE protocol
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22. Allan RW, Algood CB, Shih IeM: Metastatic epithelioid trophoblastic tumor in a male patient with mixed germ-cell tumor of the testis. Am J Surg Pathol; 2009 Dec;33(12):1902-5
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  • [Title] Metastatic epithelioid trophoblastic tumor in a male patient with mixed germ-cell tumor of the testis.
  • This report describes a rare case of a concurrent epithelioid trophoblastic tumor (ETT) and a teratoma in a para-aortic lymph node from a 39-year-old male patient with the initial diagnosis of testicular malignant mixed germ-cell tumor.
  • The metastatic lesion was excised 2 years after orchiectomy and chemotherapy.
  • Microscopically, the metastatic lesion contained a teratoma component and dispersed small nests of cohesive chorionic-type intermediate trophoblastic cells, closely resembling gestational ETT in female patients.
  • Demonstration of ETT as one of the histologic manifestations of recurrent testicular germ-cell tumors should encourage pathologists to recognize this unique feature in assessing posttreatment mixed germ-cell neoplasm.
  • Furthermore, this case represents a unique opportunity to understand the pathobiology of trophoblastic neoplasms arising from germ-cell tumors.
  • [MeSH-major] Carcinoma, Embryonal / secondary. Choriocarcinoma, Non-gestational / secondary. Epithelioid Cells / pathology. Teratoma / secondary. Testicular Neoplasms / pathology. Trophoblastic Neoplasms / secondary
  • [MeSH-minor] Adult. Chemotherapy, Adjuvant. Female. Humans. Immunohistochemistry. Lymph Node Excision. Lymphatic Metastasis. Male. Orchiectomy. Treatment Outcome

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  • (PMID = 19898219.001).
  • [ISSN] 1532-0979
  • [Journal-full-title] The American journal of surgical pathology
  • [ISO-abbreviation] Am. J. Surg. Pathol.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
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23. Koc S, Ozdegirmenci O, Tulunay G, Ozgul N, Kose MF, Bulbul D: Recurrent partial hydatidiform mole: a report of a patient with three consecutive molar pregnancies. Int J Gynecol Cancer; 2006 Mar-Apr;16(2):940-3
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Recurrent partial hydatidiform mole: a report of a patient with three consecutive molar pregnancies.
  • Hydatidiform mole (HM) is the most common form of gestational trophoblastic neoplasia and is characterized by atypical hyperplastic trophoblasts and hydropic villi.
  • In the first two molar events no additional treatment after evacuation was required, but in the last event, the beta-human chorionic gonadotropin levels increased and an invasive mole was suspected.
  • The patient required chemotherapy for treatment of persistent disease.
  • Recurrent partial HM is a very rare clinical disorder.
  • Repetitive molar pregnancy is not an indication for chemotherapy, but persistent disease does require chemotherapy.
  • [MeSH-major] Hydatidiform Mole / diagnosis. Neoplasm Recurrence, Local / diagnosis. Uterine Neoplasms / diagnosis

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  • (PMID = 16681793.001).
  • [ISSN] 1048-891X
  • [Journal-full-title] International journal of gynecological cancer : official journal of the International Gynecological Cancer Society
  • [ISO-abbreviation] Int. J. Gynecol. Cancer
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Chorionic Gonadotropin, beta Subunit, Human
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24. Wielsma S, Kerkmeijer L, Bekkers R, Pyman J, Tan J, Quinn M: Persistent trophoblast disease following partial molar pregnancy. Aust N Z J Obstet Gynaecol; 2006 Apr;46(2):119-23
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Persistent trophoblast disease following partial molar pregnancy.
  • OBJECTIVE: Human chorionic gonadotrophin (hCG) follow-up data were analysed retrospectively in all patients registered in the Hydatidiform Mole Registry at the Royal Women's Hospital, Melbourne from January 1992 to January 2001 to determine the risk of persistent trophoblast disease following partial molar pregnancy and to review the present follow-up protocol of patients suffering from partial hydatidiform molar pregnancy (PHM).
  • FINDINGS: Six of the 344 patients diagnosed with PHM required treatment with single-agent methotrexate and folinic acid rescue.
  • All six patients achieved and maintained a complete biochemical remission after chemotherapy. hCG regression assays were analysed for 235 patients: 225 patients had at least one normal hCG measurement during follow-up, of whom 152 (64.7%) patients obtained normal values within 2 months after evacuation.
  • No patient who achieved normal hCG levels required chemotherapy because of a recurrent gestational trophoblastic tumour.
  • RECOMMENDATIONS: This study indicates that 1.7% of all partial mole pregnancy patients needed treatment for malignant sequelae.
  • [MeSH-major] Chorionic Gonadotropin / blood. Hydatidiform Mole / diagnosis. Methotrexate / therapeutic use. Neoplasm Recurrence, Local / diagnosis. Uterine Neoplasms / diagnosis
  • [MeSH-minor] Adult. Australia. Biomarkers, Tumor / blood. Female. Follow-Up Studies. Gestational Age. Humans. Maternal Age. Parity. Pregnancy. Pregnancy Complications, Neoplastic / diagnosis. Pregnancy Complications, Neoplastic / drug therapy. Pregnancy Outcome. Registries. Retrospective Studies. Risk Assessment. Trophoblastic Neoplasms / diagnosis. Trophoblastic Neoplasms / drug therapy

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  • [ErratumIn] Aust N Z J Obstet Gynaecol. 2006 Jun;46(3):179. Wiesma, Sabien [corrected to Wielsma, Sabien]
  • (PMID = 16638033.001).
  • [ISSN] 0004-8666
  • [Journal-full-title] The Australian & New Zealand journal of obstetrics & gynaecology
  • [ISO-abbreviation] Aust N Z J Obstet Gynaecol
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Australia
  • [Chemical-registry-number] 0 / Biomarkers, Tumor; 0 / Chorionic Gonadotropin; YL5FZ2Y5U1 / Methotrexate
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25. Lorigan PC, Sharma S, Bright N, Coleman RE, Hancock BW: Characteristics of women with recurrent molar pregnancies. Gynecol Oncol; 2000 Sep;78(3 Pt 1):288-92
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Characteristics of women with recurrent molar pregnancies.
  • OBJECTIVES: The aim of this study was to examine the incidence and characteristics of women who develop a second molar pregnancy after a previous episode of gestational trophoblastic disease.
  • METHODS: A retrospective analysis was carried out on completed registration forms from referring hospitals in the North of England to the Sheffield Trophoblastic Screening Service over a 13-year period.
  • RESULTS: Between 1 January 1985 and 31 December 1997, 5030 patients were registered for follow-up and 275 (5.5%) required treatment for persistent disease.
  • There was no significant difference in age at first registration between those who were registered for one molar event and those who developed a subsequent molar pregnancy.
  • There was a significantly increased incidence of blood group B in patients that developed a molar pregnancy when compared to the normal population (P < 0.05), but there was no difference in distribution of blood group between those registered for their first molar event and those with two or more events.
  • Six percent of patients required chemotherapy for the second molar event, indicating no increase in aggressiveness in second moles.
  • Only 6% of patients required chemotherapy for the second mole; a second molar pregnancy is not an indication for chemotherapy.
  • [MeSH-minor] ABO Blood-Group System. Adolescent. Adult. Age Factors. Child. England / epidemiology. Ethnic Groups. Female. Humans. Incidence. Neoplasm Recurrence, Local / blood. Neoplasm Recurrence, Local / epidemiology. Neoplasm Recurrence, Local / pathology. Pregnancy. Registries

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  • [Copyright] Copyright 2000 Academic Press.
  • (PMID = 10985882.001).
  • [ISSN] 0090-8258
  • [Journal-full-title] Gynecologic oncology
  • [ISO-abbreviation] Gynecol. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] UNITED STATES
  • [Chemical-registry-number] 0 / ABO Blood-Group System
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26. Cole LA, Khanlian SA, Muller CY: Detection of perimenopause or postmenopause human chorionic gonadotropin: an unnecessary source of alarm. Am J Obstet Gynecol; 2008 Mar;198(3):275.e1-7
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Detection of perimenopause or postmenopause human chorionic gonadotropin: an unnecessary source of alarm.
  • Unfortunately, delays or cancellations of important medical procedures and use of needless chemotherapy still occurs because of the finding of human chorionic gonadotropin in perimenopausal and postmenopausal woman.
  • RESULTS: By report of the provided records, in 6 of 36 cases, unneeded chemotherapy was given for assumed recurrent gestational trophoblastic disease.
  • In 9 cases, surgery was cancelled or postponed and in 3 cases renal transplantation was cancelled at the time of locating a matched donor kidney.
  • In 24 cases, therapeutic doses of high-estrogen birth control pill were used to confirm pituitary origin with 23 cases demonstrating successful human chorionic gonadotropin suppression.
  • Understanding this physiology will avoid delays in necessary therapies such as organ transplants, and will limit the misadventure of prescribing unnecessary treatments for presumed gestational malignancy.

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  • (PMID = 18313448.001).
  • [ISSN] 1097-6868
  • [Journal-full-title] American journal of obstetrics and gynecology
  • [ISO-abbreviation] Am. J. Obstet. Gynecol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Chorionic Gonadotropin
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27. Kerkmeijer L, Wielsma S, Bekkers R, Pyman J, Tan J, Quinn M: Guidelines following hydatidiform mole: a reappraisal. Aust N Z J Obstet Gynaecol; 2006 Apr;46(2):112-8
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • OBJECTIVE: The aim of this study was to determine how often patients with complete hydatidiform mole (CHM) who spontaneously achieve normal human chorionic gonadotrophin (hCG) levels subsequently develop persistent or recurrent gestational trophoblast disease.
  • Maternal age, gestational age, gravidity and parity were determined for each patient, as well as the need for chemotherapy.
  • RESULTS: Among the 414 patients, 55 (13.3%) required chemotherapy for persistent trophoblastic disease.
  • None of the patients whose hCG levels spontaneously fell to normal subsequently developed persistent molar disease.
  • [MeSH-major] Chorionic Gonadotropin / blood. Hydatidiform Mole / diagnosis. Neoplasm Recurrence, Local / diagnosis. Practice Guidelines as Topic. Uterine Neoplasms / diagnosis
  • [MeSH-minor] Adult. Biomarkers, Tumor / blood. Chemotherapy, Adjuvant. Female. Follow-Up Studies. Humans. Hysterectomy / methods. Maternal Age. Monitoring, Physiologic / standards. Parity. Pregnancy. Pregnancy Complications, Neoplastic / diagnosis. Pregnancy Complications, Neoplastic / therapy. Pregnancy Outcome. Registries. Retrospective Studies. Risk Assessment. Sensitivity and Specificity

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  • [ErratumIn] Aust N Z J Obstet Gynaecol. 2006 Jun;46(3):179. Wiesma, Sabien [corrected to Wielsma, Sabien]
  • (PMID = 16638032.001).
  • [ISSN] 0004-8666
  • [Journal-full-title] The Australian & New Zealand journal of obstetrics & gynaecology
  • [ISO-abbreviation] Aust N Z J Obstet Gynaecol
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article
  • [Publication-country] Australia
  • [Chemical-registry-number] 0 / Biomarkers, Tumor; 0 / Chorionic Gonadotropin
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28. Lai CH, Yen TC, Chang TC: Positron emission tomography imaging for gynecologic malignancy. Curr Opin Obstet Gynecol; 2007 Feb;19(1):37-41
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Positron emission tomography imaging for gynecologic malignancy.
  • PURPOSE OF REVIEW: The utility of positron emission tomography (PET) in gynecologic malignancy has increased rapidly in recent years.
  • It is valuable in primary staging of untreated advanced cervical cancer, for posttreatment unexplained tumor marker elevation and restaging of potentially curable recurrent cervical cancer.
  • In ovarian cancer, sequential imaging predicts response to neoadjuvant chemotherapy and survival.
  • It also provides benefits when increases in serum CA 125 or computed tomography/magnetic resonance imaging defined recurrence is noted but biopsy deemed infeasible.
  • A few studies have shown that FDG-PET may facilitate optimal management of endometrial cancer, especially for posttherapy surveillance and after salvage therapy.
  • FDG-PET is potentially useful in selected gestational trophoblastic neoplasia by monitoring response and localizing viable tumors after chemotherapy.
  • The methodology and prospects of using integrated PET/computed tomography in the management of gynecological cancer are discussed.
  • SUMMARY: The role of PET or PET/computed tomography has evolved from a diagnostic tool into a potential indicator of response to treatment and prognosis.
  • [MeSH-major] Endometrial Neoplasms / radionuclide imaging. Ovarian Neoplasms / radionuclide imaging. Positron-Emission Tomography. Uterine Cervical Neoplasms / radionuclide imaging
  • [MeSH-minor] Female. Fluorodeoxyglucose F18. Humans. Neoplasm Staging / methods. Radiopharmaceuticals

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  • (PMID = 17218850.001).
  • [ISSN] 1040-872X
  • [Journal-full-title] Current opinion in obstetrics & gynecology
  • [ISO-abbreviation] Curr. Opin. Obstet. Gynecol.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't; Review
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Radiopharmaceuticals; 0Z5B2CJX4D / Fluorodeoxyglucose F18
  • [Number-of-references] 53
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