Abstract：
BACKGROUND: Gestational Trophoblastic Neoplasia (GTN) is a disease of the reproductive age group with an incidence rate of <1% among all tumors involving the female reproductive tract. It occurs because of aberrant fertilization. Patients are diagnosed early because of aggravated symptoms during pregnancy. Moreover, patients also bleed from the tumor sites, which leads to early presentation. A cure rate of 100% can be achieved with adequate treatment.
METHODS: In this literature review, the authors have brought to attention the risk factors, classification, and various treatment options in GTN patients according to their stratification as per the WHO scoring system. Patients are categorized into low and high risk based on the FIGO scoring system. Patients with low risk are treated with single-agent methotrexate or actinomycin-D. Despite the superiority of actinomycin-D in terms of efficacy, methotrexate remains the first choice of therapy in low-risk patients due to its better toxicity profile. Multi-agent chemotherapy with etoposide, methotrexate, actinomycin-D, cyclophosphamide and vincristine (EMA-CO) leads to complete remission in 93% of high-risk GTN patients. Around 40% of patients with incomplete responses are salvaged with platinum-based multi-agent chemotherapy. Isolated chemo-resistant clones can be salvaged with surgical interventions.
CONCLUSIONS: The mortality in patients with GTN has significantly reduced over time. With adequate multi-disciplinary support, patients with GTN can ultimately be cured and can spend every day healthy reproductive life.
METHODS: In this literature review, the authors have brought to attention the risk factors, classification, and various treatment options in GTN patients according to their stratification as per the WHO scoring system. Patients are categorized into low and high risk based on the FIGO scoring system. Patients with low risk are treated with single-agent methotrexate or actinomycin-D. Despite the superiority of actinomycin-D in terms of efficacy, methotrexate remains the first choice of therapy in low-risk patients due to its better toxicity profile. Multi-agent chemotherapy with etoposide, methotrexate, actinomycin-D, cyclophosphamide and vincristine (EMA-CO) leads to complete remission in 93% of high-risk GTN patients. Around 40% of patients with incomplete responses are salvaged with platinum-based multi-agent chemotherapy. Isolated chemo-resistant clones can be salvaged with surgical interventions.
CONCLUSIONS: The mortality in patients with GTN has significantly reduced over time. With adequate multi-disciplinary support, patients with GTN can ultimately be cured and can spend every day healthy reproductive life.
摘要：
背景：妊娠滋养细胞瘤（GTN）是一种生殖年龄组的疾病，在所有累及女性生殖道的肿瘤中发病率<1％。它的发生是因为受精异常。由于怀孕期间症状加重，患者被早期诊断。此外，患者也会从肿瘤部位出血，这导致了早期的介绍。通过适当的治疗可以实现100%的治愈率。
方法：在这篇文献综述中，作者已经引起了人们的注意的危险因素，分类，以及GTN患者根据WHO评分系统进行分层的各种治疗方案。根据FIGO评分系统将患者分为低风险和高风险。低风险患者接受单药甲氨蝶呤或放线菌素D治疗。尽管放线菌素-D在疗效方面具有优势，甲氨蝶呤由于其毒性更好，仍然是低危患者的首选治疗方法。依托泊苷的多药化疗，甲氨蝶呤,放线菌素D,环磷酰胺和长春新碱（EMA-CO）导致93％的高危GTN患者完全缓解。大约40％的反应不完全的患者通过基于铂的多药化疗得以挽救。分离的化学抗性克隆可以通过手术干预来挽救。
结论：随着时间的推移，GTN患者的死亡率显著降低。有足够的多学科支持，GTN患者最终可以治愈，并且可以度过每天健康的生殖生活。
方法：在这篇文献综述中，作者已经引起了人们的注意的危险因素，分类，以及GTN患者根据WHO评分系统进行分层的各种治疗方案。根据FIGO评分系统将患者分为低风险和高风险。低风险患者接受单药甲氨蝶呤或放线菌素D治疗。尽管放线菌素-D在疗效方面具有优势，甲氨蝶呤由于其毒性更好，仍然是低危患者的首选治疗方法。依托泊苷的多药化疗，甲氨蝶呤,放线菌素D,环磷酰胺和长春新碱（EMA-CO）导致93％的高危GTN患者完全缓解。大约40％的反应不完全的患者通过基于铂的多药化疗得以挽救。分离的化学抗性克隆可以通过手术干预来挽救。
结论：随着时间的推移，GTN患者的死亡率显著降低。有足够的多学科支持，GTN患者最终可以治愈，并且可以度过每天健康的生殖生活。
