Treatment and monitoring protocols for gestational trophoblastic disease

Gestational trophoblastic disease (GTD) includes invasive, hydatidiform mole, choriocarcinoma and placental site trophoblastic tumor. All these have the potential to persist and to metastasize to local or distant structures. Their rarity makes it imperative that these patients are treated in special centers. The choice of treatment depends on the type of tumor, whether it has spread to other places, and the patient's general health. Benign moles are treated surgically with evacuation of the uterus or hysterectomy followed by human chorionic gonadotropin level monitoring. Although suction dilatation and evacuation are the most frequent techniques, hysterectomy is a viable option in older patients who do not wish to preserve fertility. In malignant disease chemotherapy is the treatment of choice whereas surgery and radiotherapy, as additional options, improve the survival. Hysterectomy can reduce the amount of chemotherapy required to treat low-risk disease, whereas surgical resections, including hysterectomy, pulmonary resections, and other extirpative procedures, can be invaluable for treating patients with persistent disease. Overall, cure rate in treating these tumors is over 90%. Most women with GTD can be cured and their reproductive function can be preserved if initial management and follow-up of patients are timely and appropriate. This review summarizes all treatment options for GTD and protocols for assessment of their effects.