There are a few newer findings that I came across in a recent literature review when I searched for what’s new with choriocarcinoma.
The FIGO 2000 staging and risk factor scoring system (Ref.3) is basically unchanged from the one used earlier in this chapter. Stage I to IV are identical. This summary contains a scoring system, where a score is given for risk factors.
For instance, in table 2 a metastasis in the kidney or spleen has a score of 1, in the gastrointestinal tract a score of 2 and in the brain or liver a score of 4. Other risk factors are scored in this manner as well. The final risk score is then totalled. Any score higher than 7 is considered high risk, a score of 6 or less low risk. The significance of this new FIGO score is that gynecologists, gynecological oncologists and medical oncologists all agreed to use the same staging system, which will make it easier to compare research reports between various centers directly.
The tyrosine kinase inhibitor, genistein, was reported in Ref. 4 to inhibit growth of a choriocarcinoma cell line in tissue culture. Vascular endothelial growth factor normally stimulates cell division in this tissue culture system. Genistein, however, specifically inhibits cell division of choriocarcinoma cells. This may have important implications for treatment of patients with gestational trophoblastic disease. Future clinical trials in centers that specialize in this field will likely define the role for genistein further.
Ref. 5 summarized in detail the distribution in terms of stage and risk factors as well as treatment of 120 patients with gestational trophoblastic disease. The authors noted that treatment results were good for most patients with 95% being alive and disease free having been followed between 2 and 8 years. The deaths that did occur were patients who had liver metastases or brain metastases at the time of diagnosis. It was suggested that multi center randomized studies are required to improve on the extreme high risk patients with the use of chemotherapy.
Fertility-sparing surgery is described in Ref. 6 for trophoblastic disease of the uterus, where the patient was able to have a normal pregnancy following completed therapy. This is achieved by uterine resection of local disease and subsequent reconstruction of the uterus. A case was described where the woman was able to have two successful pregnancies following her initial gestational trophoblastic disease.
Summary
Although the terminology might at first glance be somewhat confusing, the principles of gestational trophoblastic disease are straight forward. It is a progressively invasive disease, which starts with retained placenta that gradually experiences a metamorphosis from a hydatidiform mole to an invasive mole and finally to a choriocarcinoma.
The treatment modalities that are used to treat each stage of this condition become more invasive to match the severity of the disease. Most of all, the patient who has this condition diagnosed early can get treatment to stop progression of the disease and will fare much better on the longterm than the patient who delays the diagnosis. The best results, particularly in the later stages of this disease, appear to be achieved in the large Cancer Centers who constantly update their treatment protocols according to the latest data base.
