Misc

Question 1

What are factors in WHO risk for GTD? And what score is considered high risk?

Answer 1

Age, antecedent pregnancy type, interval since last pregnancy, pretreatment hcg, tumor size, sites of mets, previous failed chemo,# mets

> or =7 is considered hi risk

Question 1

What’s the criteria for failed response gtd

Answer 1

Treatment failure was a <10% fall (three assays over four weeks) or greater than 20% rise in hCG

Question 2

When do you treat gtd after a molar pregnancy?

Answer 2

1) persistent elevation of hcg x 3 aka
2) rise in hcg >10%
3) plateau <10% decline over 2 weeks evidenced by 3 values

Question 4

What do you give patients who fail low risk gestational trophoblastic neoplasia methotrexate therapy

Answer 4

74% of patients attain complete response with pulsed dactinomycin (1.25mg/m2 q 2 wks) median number cycles:4
Covens, GOG 176. 2006

Question 4

What is percentage of low risk pts that fail and require combination chemo? What is their OS with salvage chemo?

Answer 4

30%,

close to 100%

Question 5

What is better for low risk disease, mtx or dactinomycin?

Answer 5

Pulsed dactinomycin (1.25mg/3 q 2 wks ) is superior to mtx 30 mg/m2 q wk.
CR: 69% vs 53%
GOG 174
But they used lower dose of mtx, also allowed x -over. GOG 275 looking at mtx of 50mg/m2 vs act D

Question 6

How do you treat brain mets from gtd?

Answer 6

Intravenous methotrexate 1 g/m² which is an escalation of EMA

Question 7

Do you give high-risk patients with gestational trophoblastic disease prophylactic chemo to the brain?

Answer 7

In Charing Cross, high-risk patients receive three intrathecal injections of 12.5 mg of methotrexate every two weeks with CO chemo

Question 8

In patients with high disease burden in the thorax, what does charring Cross do?

Answer 8

Because one third of the deaths in high-risk patients occur within four weeks of starting chemo, deaths were due to Hemorrhage or respiratory compromise in the thorax, the give induction etop and platinum(EP) before EMACO

Question 9

What options are there for patients that fail EMACO?

Answer 9

EMA/EP,
Taxol + etoposide / cis taxol
MAC, CHAMOCA,VPB
Thoracotomy or hysterectomy 
Stereotactic RT to intracranial mets
High dose chemo with stem cell rescue

Question 10

For pregnancy outcomes after mole, what is chance of a repeat mole? What about a term delivery? for subsequent pregnancies, when should you get hcg?

Answer 10

1.4%
75%
hcg at 6, 10 weeks and then 6 weeks pospartum

Question 11

What is a quiescent GTN?

Answer 11

real hcg that persists at low level for weeks/months with neg w/u. chemo is not effective but then 6-10% will recur with rising hcg-hyperglycosylated (should be 30% hcg-H). chemo can treat at that point

Question 12

what is phantom hcg?

Answer 12

it is due to heterophile ab that cross react with the assay. it would be + in serum and - in the urine. does not dilute

Question 13

What type of hcg is hallmark of PSTT? How do you treat PSTT? what is found on path?

Answer 13

Free beta hcg.
Treat with hysterectomy and lymph nodes, it tends to be chemoresistant. If need chemo, Ema/ep. Intermediate trophoblasts.

Question 14

For low risk GTN, if you fail one single agent, you…?

Answer 14

can cross over to the other. Act DMtx. Then if fail both, EMA-Co

Question 15

FIGO IV: what are options for treatment

Answer 15

combo chemo, if intracranial brain mets can give RT 30Gy, can consider resection (liver resection, thoracotomy) embolize for hemorrhage

Question 16

if you see a vaginal lesion, do you bx? resect?

Answer 16

NO

Question 17

what is the workup for GTN?

Answer 17

PE, cbc, renal/lft, cxr or CT. If + lung, vaginal mets or chorio, then get ab CT/ Brain MRI

Question 18

Do you repeat D&C for presistant mole?

Answer 18

It is being studied in GOG 242