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Hextan Y.s. Ngan - One of the best experts on this subject based on the ideXlab platform.

  • Trophoblastic Disease Review for Diagnosis and Management: A Joint Report From the International Society for the Study of Trophoblastic Disease, European Organisation for the Treatment of Trophoblastic Disease, and the Gynecologic Cancer InterGroup
    International Journal of Gynecologic Cancer, 2014
    Co-Authors: Giorgia Mangili, Domenica Lorusso, Jubilee Brown, Jacobus Pfisterer, Leon Massuger, Michelle Vaughan, Hextan Y.s. Ngan, Francois Golfier, Paradan K. Sekharan, Rafael Cortés Charry
    Abstract:

    ObjectiveThe objective of this study was to provide a consensus review on gestational Trophoblastic Disease diagnosis and management from the combined International Society for the Study of Trophoblastic Disease, European Organisation for the Treatment of Trophoblastic Disease, and the Gynecologic Cancer InterGroup.MethodsA joint committee representing various groups reviewed the literature obtained from PubMed searches.Results and ConclusionsGuidelines were constructed on the basis of literature review. After initial diagnosis in local centers, centralization of pathology review and ongoing care is recommended to achieve the best outcomes.

  • Trophoblastic Disease review for diagnosis and management: a joint report from the International Society for the Study of Trophoblastic Disease, European Organisation for the Treatment of Trophoblastic Disease, and the Gynecologic Cancer InterGroup.
    International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 2014
    Co-Authors: Giorgia Mangili, Domenica Lorusso, Jubilee Brown, Jacobus Pfisterer, Leon Massuger, Michelle Vaughan, Hextan Y.s. Ngan, Francois Golfier, Paradan K. Sekharan, Rafael Cortés Charry
    Abstract:

    The objective of this study was to provide a consensus review on gestational Trophoblastic Disease diagnosis and management from the combined International Society for the Study of Trophoblastic Disease, European Organisation for the Treatment of Trophoblastic Disease, and the Gynecologic Cancer InterGroup. A joint committee representing various groups reviewed the literature obtained from PubMed searches. Guidelines were constructed on the basis of literature review. After initial diagnosis in local centers, centralization of pathology review and ongoing care is recommended to achieve the best outcomes.

  • gestational Trophoblastic Disease
    Best Practice & Research in Clinical Obstetrics & Gynaecology, 2012
    Co-Authors: Ka Yu Tse, Hextan Y.s. Ngan
    Abstract:

    Most women with gestational Trophoblastic Disease are of reproductive age. Because the Disease is readily treatable with favourable prognosis, fertility becomes an important issue. Hydatidiform mole is a relatively benign Disease, and most women do not require chemotherapy after uterine evacuation. A single uterine evacuation has no significant effect on future fertility, and pregnancy outcomes in subsequent pregnancies are comparable to that of the general population, despite a slight increased risk of developing molar pregnancy again. If women develop persistent Trophoblastic Disease, single or combined chemotherapy will be needed. Although ovarian dysfunction after chemotherapy is a theoretical risk, a term live birth rate of higher than 70% has been reported without increased risk of fetal abnormalities. Successful pregnancies have also been reported after choriocarcinoma. Only a few case reports have been published on fertility-sparing treatment in placental-site Trophoblastic tumour, and the successful rate is about 67%. Women are advised to refrain from pregnancy for at least 6 months after a molar pregnancy, and at least 12 months after a gestational Trophoblastic neoplasia. Most of the contraceptive methods do not have an adverse effect on the return of fertility. Finally, at least one-half of these women suffer from some form of psychological or sexual problems. Careful counselling and involvement of a multi-disciplinary team are mandated.

Giorgia Mangili - One of the best experts on this subject based on the ideXlab platform.

  • mental representations of illness in patients with gestational Trophoblastic Disease how do patients perceive their condition
    PLOS ONE, 2016
    Co-Authors: Valentina E Di Mattei, Giorgia Mangili, Letizia Carnelli, Martina Mazzetti, Martina Bernardi, Rossella Di Pierro, Alice Bergamini, Massimo Candiani, Lucio Sarno
    Abstract:

    Background Gestational Trophoblastic Disease comprises a group of benign and malignant disorders that derive from the placenta. Using Leventhal’s Common-Sense Model as a theoretical framework, this paper examines illness perception in women who have been diagnosed with this Disease. Methods Thirty-one women diagnosed with Gestational Trophoblastic Disease in a hospital in Italy were asked to complete the Illness Perception Questionnaire-Revised to measure the following: illness Identity, illness opinions and causes of Gestational Trophoblastic Disease. Results High mean scores were observed in the Emotional representations and Treatment control subscales. A significant difference emerged between hydatidiform mole patients and those with gestational Trophoblastic neoplasia on the Identity subscale. A significant correlation emerged between “time since diagnosis” and the Treatment control subscale. Discussion This study is the first to investigate illness perception in Gestational Trophoblastic Disease. From a clinical perspective the results highlight the need for multidisciplinary support programs to promote a more realistic illness perception.

  • Trophoblastic Disease Review for Diagnosis and Management: A Joint Report From the International Society for the Study of Trophoblastic Disease, European Organisation for the Treatment of Trophoblastic Disease, and the Gynecologic Cancer InterGroup
    International Journal of Gynecologic Cancer, 2014
    Co-Authors: Giorgia Mangili, Domenica Lorusso, Jubilee Brown, Jacobus Pfisterer, Leon Massuger, Michelle Vaughan, Hextan Y.s. Ngan, Francois Golfier, Paradan K. Sekharan, Rafael Cortés Charry
    Abstract:

    ObjectiveThe objective of this study was to provide a consensus review on gestational Trophoblastic Disease diagnosis and management from the combined International Society for the Study of Trophoblastic Disease, European Organisation for the Treatment of Trophoblastic Disease, and the Gynecologic Cancer InterGroup.MethodsA joint committee representing various groups reviewed the literature obtained from PubMed searches.Results and ConclusionsGuidelines were constructed on the basis of literature review. After initial diagnosis in local centers, centralization of pathology review and ongoing care is recommended to achieve the best outcomes.

  • Trophoblastic Disease review for diagnosis and management: a joint report from the International Society for the Study of Trophoblastic Disease, European Organisation for the Treatment of Trophoblastic Disease, and the Gynecologic Cancer InterGroup.
    International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 2014
    Co-Authors: Giorgia Mangili, Domenica Lorusso, Jubilee Brown, Jacobus Pfisterer, Leon Massuger, Michelle Vaughan, Hextan Y.s. Ngan, Francois Golfier, Paradan K. Sekharan, Rafael Cortés Charry
    Abstract:

    The objective of this study was to provide a consensus review on gestational Trophoblastic Disease diagnosis and management from the combined International Society for the Study of Trophoblastic Disease, European Organisation for the Treatment of Trophoblastic Disease, and the Gynecologic Cancer InterGroup. A joint committee representing various groups reviewed the literature obtained from PubMed searches. Guidelines were constructed on the basis of literature review. After initial diagnosis in local centers, centralization of pathology review and ongoing care is recommended to achieve the best outcomes.

Rafael Cortés Charry - One of the best experts on this subject based on the ideXlab platform.

John T. Soper - One of the best experts on this subject based on the ideXlab platform.

  • gestational Trophoblastic Disease current evaluation and management
    Obstetrics & Gynecology, 2021
    Co-Authors: John T. Soper
    Abstract:

    This review summarizes the current evaluation and management of gestational Trophoblastic Disease, including evacuation of hydatidiform moles, surveillance after evacuation of hydatidiform mole and the diagnosis and management of gestational Trophoblastic neoplasia. Most women with gestational Trophoblastic Disease can be successfully managed with preservation of reproductive function. It is important to manage molar pregnancies properly to minimize acute complications and to identify gestational Trophoblastic neoplasia promptly. Current International Federation of Gynecology and Obstetrics guidelines for making the diagnosis and staging of gestational Trophoblastic neoplasia allow uniformity for reporting results of treatment. It is important to individualize treatment based on their risk factors, using less toxic therapy for patients with low-risk Disease and aggressive multiagent therapy for patients with high-risk Disease. Patients with gestational Trophoblastic neoplasia should be managed in consultation with an individual experienced in the complex, multimodality treatment of these patients.

  • gestational Trophoblastic Disease
    Obstetrics & Gynecology, 2006
    Co-Authors: John T. Soper
    Abstract:

    This review summarizes the primary management of molar pregnancies, surveillance after evacuation, and the evaluation and management of malignant gestational Trophoblastic neoplasia (GTN). Most women with gestational Trophoblastic Disease can be successfully managed with preservation of their normal reproductive function. It is important to manage molar pregnancies properly to minimize acute complications and identify malignant sequelae promptly. Current International Federation of Gynecology and Obstetrics (FIGO) guidelines for making the diagnosis and staging of GTN allow uniformity for reporting results of treatment. It is important to individualize treatment for women with malignant GTN based upon risk factors, using less toxic therapy for patients with low-risk Disease and aggressive multiagent therapy for those with high-risk Disease. Patients with malignant GTN should be managed in consultation with an individual experienced in the complex, multimodality treatment of these patients.

  • diagnosis and treatment of gestational Trophoblastic Disease acog practice bulletin no 53
    Gynecologic Oncology, 2004
    Co-Authors: John T. Soper, David G. Mutch, Julian C. Schink
    Abstract:

    Gestational Trophoblastic Disease comprises a spectrum of interrelated conditions originating from the placenta. Other terms often used to refer to these conditions include gestational Trophoblastic neoplasia and gestational Trophoblastic tumor. Histologically distinct Disease entities encompassed by this general terminology include complete and partial hydatidiform moles, invasive moles, gestational choriocarcinomas, and placental site Trophoblastic tumors. Before the advent of sensitive assays for human chorionic gonadotropin (hCG) and efficacious chemotherapy, the morbidity and mortality from gestational Trophoblastic Disease were substantial. At present, with sensitive quantitative assays for beta-hCG and current approaches to chemotherapy, most women with malignant gestational Trophoblastic Disease can be cured and their reproductive function preserved. The purpose of this document is to address current evidence regarding the diagnosis, staging, and management of gestational Trophoblastic Disease.

  • in the management of gestational Trophoblastic Disease
    2003
    Co-Authors: John T. Soper
    Abstract:

    Although sensitive human chorionic gonadotrophin (hCG) assays and advances in chemotherapy have assumed primary importance in the management of gestational Trophoblastic Disease (GTD), surgery and radiation therapy remain important in the overall management of patients. Management of molar pregnancies consists of surgical evacuation and subsequent monitoring. Hysterectomy may decrease the risk of post-molar Trophoblastic Disease. When incorporated into the primary management of malignant GTD, hysterectomy decreases chemotherapy requirements for patients with low-risk Disease. Surgical intervention is frequently required to control complications of Disease or as therapy to stabilize patients during chemotherapy. Salvage hysterectomy or other extirpative procedures may be integrated into the management of patients with chemorefractory Disease. Interventional radiographical techniques are useful adjuncts to control haemorrhage from vaginal or pelvic metastases. Radiation therapy may also be combined with chemotherapy for the management of patients with brain metastases or, rarely, isolated metastases at other sites.

  • 5 day methotrexate for women with metastatic gestational Trophoblastic Disease
    ACOG Current Journal Review, 1995
    Co-Authors: John T. Soper, Daniel L Clarkepearson, Andrew Berchuck, Gustavo C Rodriguez, C Hammond
    Abstract:

    The objective of this study was to analyze the toxicity and the efficacy of single-agent 5-day methotrexate for women with metastatic gestational Trophoblastic Disease. The study is a retrospective analysis of 52 patients who received repetitive 5-day cycles of intramuscular methotrexate as primary therapy for metastatic Trophoblastic Disease between 1975 and 1990. The majority of patients were low-risk by both clinical and World Health Organization prognostic index score criteria. Sixty percent achieved primary remission with a median of 3 cycles of single-agent methotrexate. Therapy was changed because of toxicity and drug-resistance by hCG criteria in 11 (21%) and 10 (19%) patients, respectively. Pretherapy hCG > 10,000 mIU/ml was associated with the development of drug-resistance. Remission was achieved in all patients, with only 2 (4%) requiring multiagent therapy. The use of repetitive 5-day cycles of methotrexate is efficacious therapy of low-risk metastatic Trophoblastic Disease. Future studies are needed to define a cost-effective and minimally toxic therapy that retains a high primary remission rate in these patients.

Robert E Coleman - One of the best experts on this subject based on the ideXlab platform.

  • the role of repeat uterine evacuation in the management of persistent gestational Trophoblastic Disease
    Gynecologic Oncology, 2004
    Co-Authors: M Pezeshki, John Anthony Tidy, Barry W. Hancock, Jan Everard, Paul Silcocks, J M Coleman, Alan M Gillespie, Robert E Coleman
    Abstract:

    Abstract Objective. To evaluate the role of second (and third) uterine evacuation in the management of persistent gestational Trophoblastic Disease (GTD). Methods. This was an observational study of all cases registered over a 10-year period at the Trophoblastic Disease Centre at Weston Park Hospital, Sheffield. Five hundred and forty-four of 4050 women registered during 1991–2000 underwent a second uterine evacuation following a presumptive diagnosis of persistent GTD. The reason for evacuation, hCG level prior to the procedure, histological appearances of evacuated products and the clinical outcome (in terms of the need for chemotherapy) were determined. Results. After a second uterine evacuation 368 patients (68%) completed the follow-up programme without further evidence of persistent Disease or need for chemotherapy. If the diagnosis of persistent GTD was confirmed solely on the basis of elevated hCG levels then 171 of 282 (60%) patients did not require chemotherapy. Chemotherapy was more likely where there was histological evidence of persistent Trophoblastic Disease and where the urinary hCG was >1500 IU/L at the time of the repeat evacuation. Twenty-eight of 60 patients (46%) undergoing a third evacuation required chemotherapy. Conclusion. Second uterine evacuation can be a useful therapeutic option for patients with presumed persistent Trophoblastic Disease not mandating immediate chemotherapy, particularly where the hCG level is