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GY50 Gynecology
Gynecological Oncology Toronto Notes 2019 Table 30. FIGO Staging and Management of Malignant GTN
Stage Findings
I Disease confined to uterine corpus
II Metastatic disease to genital structures
III Metastatic disease to lungs with or without genital tract
involvement
IV Distant metastatic sites including brain, liver, kidney, GI tract
Table 31. WHO Prognostic Score for GTD (2011)
Management
Single agent chemotherapy for low risk disease (WHO score ≤6)
1st line: pulsed – actinomycin D (Act-D) IV q2wk
Alternatives: MTX-based regimen
20% of patients need to switch to alternate single-agent regimen due to failure of β-hCG to return to normal
Combination chemotherapy (EMA-CO: etoposide, MTX, ACT-D, cyclophosphamide, vincristine) if high risk (WHO score ≥7) or if resistant to single agent chemotherapy
Can consider hysterectomy if fertility not desired or placental-site trophoblastic tumour
As above As above
Usually high risk (EMA-CO) with surgical resection of sites of disease Persistence/resistance to chemotherapy
Consider radiation for brain mets
Score
2
Term 7-13
104-105 5-8
GI tract >5 cm Single drug
Prognostic Factor 0
Maternal Age >40 Antecedent Pregnancy Mole
Interval (end of <4 Antecedent Pregnancy
to chemotherapy in
months)
HCG IU/1 <103 Number of 0
Metastases
Site of Metastases Lung Largest Tumour Mass
Prior Chemotherapy
Follow-up (for GTN)
1
40 Abortion 4-6
103-104 1-4
Spleen, kidney 3-5 cm
4
>13
>105 >8
Brain, liver Two drug
• contraceptionforallstagestoavoidpregnancyduringentirefollow-upperiod • stageI,II,III
■ weekly β-hCG until 3 consecutive normal results
■ then monthly x 12 mo • stageIV
■ weekly β-hCG until 3 consecutive normal results ■ then monthly x 24 mo
GTN Diagnosis
• β-hCGplateau:<10%dropinβ-hCGoverfourvaluesin3wk(e.g.days1,7,14,and21)OR • β-hCGrise>20%inanytwovaluesovertwowkorlonger(e.g.measureatdays1,7,14)OR • β-hCGpersistentlyelevated>6moOR
• metastasesonworkup