Treatment
Of Gestational Trophoblastic Disease1. In many cases a hydatiform
mole may spontaneously dissolve on its own and be expelled. In this
case the physician will follow the beta-hCG for awhile to ensure that all of the
trophoblastic tissue was expelled and there is no recurrence. The woman also is
usually treated with 6 months of contraceptive medication. 2. If a mole
comes back or it does not dissolve spontaneously, the doctor has
to remove it with suction curettage, where all of the
hydatidiform tissue is removed from the uterine cavity. This is carefully monitored
with beta-HCG levels later to ensure that the last tissue bits have been removed.
It takes about 10-12 weeks for the blood titre to clear even when all the tissue
has been removed. The direction of the elimination curve, when the titers are
plotted as a graph, will tell the physician whether or not all the tissue has
been removed or not. About 80% of patients do not need any further therapy than
this. 3. High risk molar pregnancy is
being treated with combination chemotherapy consisting of methotrexate,
dactinomycin and chlorambucil. Several courses are given until the beta-HCG levels
are normal for 3 successive weeks. There are other successful combination chemotherapy
regimens. In most patients with multiple metastases there is a success rate of
80%, which is excellent when compared with old figures just a few decades ago.
However, patients with liver and brain metastases only give response rates of
60% to 70%. 4. For patients with brain
or liver metastases special protocols have been developed
where combination chemotherapy with 6 or 7 drugs is used and at
the same time radiotherapy to the metastases in the liver or in the brain is also
given. The end point for brain metastses has to be defined by taking cerebrospinal
fluid samples through lumbar puncture and sending these samples for beta-HCG analysis
until levels turn negative. Here is the 10-year survival data when the above guidelines
were followed (Ref. 2):
10-year
survival for gestational trophoblastic disease |
| Stage: | 10-year
survival ( % ): | | 0 A | 98
% | | 0 B | 95
% | | I * | 90
% | | II ** | 88
% | | III | 68
% | | IV | 60
% |
| * locally invasive hydatidiform mole |
| ** stage II to IV are called choriocarcinoma |
Compared to only a few decades ago these
survival statistics are amazingly good as at that time for stage I a typical cancer
survival rates for 10-years would have been only 40% and for stage IV a highly
successful survival rate would have been about 10%! As always, with any kind of
cancer, early detection and prompt treatment is extremely important as can be
seen from this table.
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