Current management of gestational trophoblastic neoplasia

Hematology/Oncology Clinics of North America

Volumn 26, Issue 1, 2012, Pages 111-131

  Goldstein, Donald Peter ^a   Berkowitz, Ross S ^a  

^a BRIGHAM AND WOMEN S HOSPITAL   (United States)

Author keywords

Choriocarcinoma; Gestational trophoblastic neoplasia; Human chorionic gonadotropin; Invasive mole

Indexed keywords

ANTINEOPLASTIC AGENT; BLEOMYCIN; CARBOPLATIN; CHLORAMBUCIL; CHORIONIC GONADOTROPIN; CISPLATIN; CYCLOPHOSPHAMIDE; DACTINOMYCIN; ETOPOSIDE; FOLINIC ACID; IFOSFAMIDE; METHOTREXATE; PACLITAXEL; VINBLASTINE; VINCRISTINE;

AUTOLOGOUS BONE MARROW TRANSPLANTATION; CANCER COMBINATION CHEMOTHERAPY; CANCER DIAGNOSIS; CANCER MORTALITY; CANCER RESISTANCE; CANCER RISK; CANCER STAGING; CANCER SURVIVAL; CENTRAL NERVOUS SYSTEM METASTASIS; CHORIOCARCINOMA; COMPLETE HYDATIDIFORM MOLE; COMPUTER ASSISTED TOMOGRAPHY; DRUG MEGADOSE; ECHOGRAPHY; EPITHELIOID TROPHOBLASTIC TUMOR; HAIR LOSS; HUMAN; HYDATIDIFORM MOLE; HYSTERECTOMY; LIVER METASTASIS; LUNG METASTASIS; METASTASIS; MYOMETRIUM; NAUSEA AND VOMITING; NUCLEAR MAGNETIC RESONANCE IMAGING; PARTIAL HYDATIDIFORM MOLE; PREGNANCY; PREMATURITY; PRIORITY JOURNAL; RASH; REPRODUCTION; REVIEW; RISK ASSESSMENT; SPONTANEOUS ABORTION; THORACOTOMY; THORAX RADIOGRAPHY; TREATMENT RESPONSE; TROPHOBLASTIC TUMOR; UNSPECIFIED SIDE EFFECT; UTERINE TUBE PREGNANCY;

CENTRAL NERVOUS SYSTEM NEOPLASMS; FEMALE; FOLLOW-UP STUDIES; GESTATIONAL TROPHOBLASTIC DISEASE; HUMANS; LIVER NEOPLASMS; LUNG NEOPLASMS; NEOPLASM STAGING; PREGNANCY; PREGNANCY COMPLICATIONS, NEOPLASTIC; RISK ASSESSMENT;

EID: 84855866971     PISSN: 08898588     EISSN: 15581977     Source Type: Journal    
DOI: 10.1016/j.hoc.2011.10.007     Document Type: Review

References (125)

1. Berkowitz R.S., Goldstein D.P. Current management of gestational trophoblastic disease. Gynecol Oncol 2009, 112:654-662.
2. Bracken M.B. Incidence and aetiology of hydatidiform mole: an epidemiologic review. Br J Obstet Gynaecol 1987, 94:1123-1135.
3. Palmer J.R. Advances in the epidemiology of gestational trophoblastic disease. JReprod Med 1994, 39:155-162.
4. Atrash H.K., Hogue C.J., Grimes D.A. Epidemiology of hydatidiform mole during early gestation. Am J Obstet Gynecol 1986, 154:906-909.
5. Bagshawe K.D., Dent J., Webb J. Hydatidiform mole in England and Wales 1973-83. Lancet 1986, 2:673-677.
6. Takeuchi S. Incidence of gestational trophoblastic disease by regional registration in Japan. Hum Reprod 1987, 2:729-734.
7. Smith H.O. Gestational trophoblastic disease. Epidemiology and trends. Clin Obstet Gynecol 2003, 46:541-556.
8. Parazzini F., Mangili G., LaVecchia C., et al. Risk factors for gestational trophoblastic disease: a separate analysis of complete and partial hydatidiform moles. Obstet Gynecol 1991, 78:1039-1045.
9. Sebire N.J., Foskett M., Fisher R.A., et al. Risk of partial and complete molar pregnancy in relation to maternal age. Br J Obstet Gynaecol 2002, 109:99-102.
10. Wang C.M., Dixon P.H., Decordova S., et al. Identification of 13 novel NLRP7 mutations in 20 families with recurrent hydatidiform mole; missense mutations cluster in the leucine-rich area. JMed Genet 2009, 46:569-575.
11. Berkowitz R.S., Cramer D.W., Bernstein M.R., et al. Risk factors for complete molar pregnancy from a case-control study. Am J Obstet Gynecol 1985, 152:1016-1020.
12. Parazzini F., LaVecchia C., Mangili G., et al. Dietary factors and risk of trophoblastic disease. Am J Obstet Gynecol 1988, 158:93-99.
13. Martin B.H., Kim J.M. Changes in gestational trophoblastic tumors over four decades: a Korean experience. JReprod Med 1998, 43:60-68.
14. Brinton L.A., Bracken M.B., Connelly R.R. Choriocarcinoma incidence in the United States. Am J Epidemiol 1986, 123:1094-1100.
15. Smith H.O., Qualls C.R., Prarie B.A., et al. Trends in gestational choriocarcinoma: a 27-year perspective. Obstet Gynecol 2003, 102:978-987.
16. Berkowitz R.S., Goldstein D.P. Molar pregnancy. NEngl J Med 2009, 360:1639-1645.
17. Lurain J.R., Brewer J.I. Invasive mole. Semin Oncol 1982, 9:174-180.
18. Baergen R.N., Rutgers J.L., Young R.H., et al. Placental site trophoblastic tumor: a study of 55 cases and review of the literature emphasizing factors of prognostic significance. Gynecol Oncol 2006, 100:511-520.
19. Shih I.M., Kurman R.J. Epithelioid trophoblastic tumor: a neoplasm distinct from choriocarcinoma and placental site trophoblastic tumour simulating carcinoma. Am J Surg Pathol 1998, 22:1393-1403.
20. Allison K.H., Love J.E., Garcia R.L. Epithelioid trophoblastic tumor: review of a rare neoplasm of the chorionic-type intermediate trophoblast. Arch Pathol Lab Med 2006, 130:1875-1877.
21. Soto-Wright V., Bernstein M.R., Goldstein D.P., et al. The changing clinical presentation of complete molar pregnancy. Obstet Gynecol 1995, 86:775-779.
22. Kohorn E.I. Negotiating a staging and risk factor scoring system for gestational trophoblastic neoplasia. A progress report. JReprod Med 2002, 47:445-450.
23. Goldstein D.P., Zanten-Przybysz I.V., Bernstein M.R., et al. Revised FIGO staging system for gestational trophoblastic tumors; recommendations regarding therapy. JReprod Med 1998, 43:37-43.
24. Garner E.I., Garrett A., Goldstein D.P., et al. Significance of chest computed tomography findings in the evaluation and treatment of persistent gestational trophoblastic neoplasia. JReprod Med 2004, 49:411-414.
25. Van Trommel N.E., Massuger L.F., Verheijen R.H., et al. The curative effect of a second curettage in persistent trophoblastic disease: a retrospective cohort study. Gynecol Oncol 2005, 99:6-13.
26. Garner E.I., Feltmate C.M., Goldstein D.P., et al. The curative effect of a second curettage in persistent trophoblastic disease: a retrospective cohort study. Gynecol Oncol 2005, 99:3-5.
27. Bagshawe K.D., Harland S. Immunodiagnosis and monitoring of gonadotropin-producing metastases in the central nervous system. Cancer 1976, 38:112-118.
28. Bakri Y.N., Al-Hawashim N., Berkowitz R.S. Cerebrospinal fluid/serum beta subunit human chorionic gonadotropin ratio in patients with brain metastases of gestational trophoblastic tumor. JReprod Med 2000, 45:94-96.
29. Dhillon T., Palmieri C., Sebire N.J., et al. Value of whole body 18 FDG-PET to identify the active site of gestational trophoblastic neoplasia. JReprod Med 2006, 51:879-887.
30. Lurain J.R. Pharmacotherapy of gestational trophoblastic disease. Expert Opin Pharmacother 2003, 4:1-13.
31. Alazzam M., Tidy J.A., Hancock B.W., et al. First line chemotherapy in low risk gestational trophoblastic neoplasia. Cochrane Database Syst Rev 2009, 1. CD007102.
32. Homesely H.D., Blessing J.A., Rettenmaier M., et al. Weekly intramuscular methotrexate for nonmetastatic gestational trophoblastic disease. Obstet Gynecol 1988, 72:413-418.
33. Homesley H.D., Blessing J.A., Schlaerth J., et al. Rapid escalation of weekly intramuscular methotrexate for nonmetastatic gestational trophoblastic disease. A Gynecologic Oncology Group study. Gynecol Oncol 1990, 39:305-308.
34. Hoffman M.S., Fiorica J.V., Gleeson N.C., et al. Asingle institution experience with weekly intramuscular methotrexate for nonmetastatic gestational trophoblastic disease. Gynecol Oncol 1996, 60:292-294.
35. Berkowitz R.S., Goldstein D.P., Bernstein M.R. Methotrexate infusion with folinic acid in primary therapy of nonmetastatic trophoblastic tumors. Gynecol Oncol 1990, 36:56-59.
36. Elit L., Coven A., Osborne R., et al. High-dose methotrexate for gestational trophoblastic disease. Gynecol Oncol 1994, 54:282-287.
37. Wong L.C., Ngan H.Y., Cheng D.K., et al. Methotrexate infusion in low-risk gestational trophoblastic disease. Am J Obstet Gynecol 2000, 183:1579-1582.
38. Schlaerth J.B., Morrow C.P., Nalick R.H., et al. Single-dose actinomycin D in the treatment of postmolar trophoblastic disease. Gynecol Oncol 1984, 19:53-56.
39. Petrilli E.S., Twiggs L.B., Blessing J.A., et al. Single-dose actinomycin D treatment for nonmetastatic gestational trophoblastic disease; a prospective phase II trial of the Gynecologic Oncology Group. Cancer 1987, 60:2173-2176.
40. Gilani M.M., Yarandi F., Eftekhar Z., et al. Comparison of pulse methotrexate and pulse actinomycin D in the treatment of low-risk gestational trophoblastic neoplasia. Aust N Z J Obstet Gynecol 2005, 45:161-164.
41. Yerandi F., Eftekhar Z., Shojaei H., et al. Pulse methotrexate versus pulse actinomycin D in the treatment of low-risk gestational trophoblastic neoplasia. Int J Gynaecol Obstet 2008, 103:33-37.
42. Osborne R., Filiaci V., Schink J., et al. Arandomized phase III trial comparing weekly parental methotrexate and pulsed dactinomycin as primary management of low-risk gestational trophoblastic neoplasia: A Gynecologic Oncology Group study. JClin Oncol 2011, 29:825-831.
43. Smith E.B., Weed J.C., Tyrey L., et al. Treatment of nonmetastatic gestational trophoblastic disease: results of methotrexate alone versus methotrexate-folinic acid. Am J Obstet Gynecol 1982, 144:88-92.
44. Gleeson N.C., Finan M.A., Fiorica J.V., et al. Non-metastatic gestational trophoblastic disease: Weekly methotrexate compared with 8-day methotrexate-folinic acid. Eur J Gynaecol Oncol 1993, 14:461-465.
45. Lertkhachonsuk A., Israngura N., Wilailak S., et al. Actinomycin D versus methotrexate-folinic acid as the treatment of stage I, low-risk gestational trophoblastic neoplasia. A randomized controlled trial. Int J Gynecol Cancer 2009, 19:985-988.
46. Kohorn E.I. Decision making for chemotherapy administration in patients with low-risk gestational trophoblastic neoplasia. Int J Gynecol Oncol 1996, 6:279-285.
47. Berkowitz R.S., Goldstein D.P., Jones M.A., et al. Methotrexate with citrovorum factor rescue: reduced chemotherapy toxicity in the management of gestational trophoblastic neoplasms. Cancer 1980, 45:423-426.
48. Petrilli E.S., Morrow C.P. Actinomycin D toxicity in the treatment of trophoblastic disease. A comparison of the 5-day course to single dose administration. Gynecol Oncol 1980, 9:18-22.
49. Growdon W.B., Wolfberg A.J., Goldstein D.P., et al. Evaluating methotrexate therapy in patients with low-risk post-molar gestational trophoblastic neoplasia. Gynecol Oncol 2009, 112:353-357.
50. Hammond C.B., Borchert L.G., Tyrey L., et al. Treatment of metastatic trophoblastic disease: good and poor prognosis. Am J Obstet Gynecol 1973, 115:451-457.
51. Rustin G.J., Newlands E.S., Lutz J.M., et al. Combination but not single-agent methotrexate chemotherapy for gestational trophoblastic tumors increases the incidence of second tumors. JClin Oncol 1996, 14:2769-2773.
52. Dubeshter B., Berkowitz R.S., Goldstein D.P., et al. Metastatic gestational trophoblastic disease: Experience at the New England Trophoblastic Disease Center, 1965-1985. Obstet Gynecol 1987, 69:390-395.
53. Begent R.H., Bagshawe K.D. The management of high- risk choriocarcinoma. Semin Oncol 1982, 9:198-203.
54. Curry S.L., Blessing J.A., DiSaia P.J., et al. Aprospective randomized comparison of methotrexate, dactinomycin and chlorambucil versus methotrexate, dactinomycin, cyclophosphamide, doxorubicin, melphalan, hydroxyurea, and vincristine in poor prognosis metastatic gestational trophoblastic disease: a Gynecologic Oncology Group study. Obstet Gynecol 1989, 73:357-362.
55. Wong L.C., Choo Y.C., Ma H.K. Primary oral etoposide therapy in gestational trophoblastic disease, an update. Cancer 1986, 58:14-17.
56. Newlands E.S., Bagshawe K.D., Begent R.H., et al. Results with EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) regimen in high-risk gestational trophoblastic tumors, 1979-1989. Br J Obstet Gynaecol 1991, 98:550-557.
57. Bolis G., Bonazzi C., Landoni F., et al. EMA/CO regimen in high-risk gestational trophoblastic tumor (GTT). Gynecol Oncol 1988, 31:439-444.
58. Bower M., Newlands E.S., Holden L., et al. EMA/CO for high-risk gestational trophoblastic tumors: results from a cohort of 272 patients. JClin Oncol 1997, 15:2636-2643.
59. Kim S.J., Bae S.N., Kim J.H., et al. Risk factors for the prediction of treatment failure in gestational trophoblastic tumors treated with EMA/CO regimen. Gynecol Oncol 1998, 71:247-253.
60. Matsui H., Suzuka K., Litsika Y., et al. Combination chemotherapy with methotrexate, etoposide and actinomycin D for high-risk gestational trophoblastic tumors. Gynecol Oncol 2000, 78:28-31.
61. Escobar P.F., Lurain J.R., Singh D.K., et al. Treatment of high-risk gestational trophoblastic neoplasia with etoposide, methotrexate actinomycin D, cyclophosphamide, and vincristine chemotherapy. Gynecol Oncol 2003, 91:552-557.
62. Lurain J.R., Singh D.K., Schink J.C. Primary treatment of metastatic high-risk gestational trophoblastic neoplasia with EMA-CO chemotherapy. JReprod Med 2006, 51:767-772.
63. Turan T., Karacay O., Tulunay G., et al. Results with EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) chemotherapy in gestational trophoblastic neoplasia. Int J Gynecol Oncol 2006, 16:1432-1438.
64. Lu W.G., Ye F., Shen Y.M., et al. EMA-CO chemotherapy for high-risk gestational trophoblastic neoplasia: a clinical analysis of 54 patients. Int J Gynecol Oncol 2008, 18:357-362.
65. Lurain J.R., Nejad B. Secondary chemotherapy for high-risk gestational trophoblastic neoplasia. Gynecol Oncol 2005, 97:618-623.
66. Mao Y., Wan X., Lv W., et al. Relapsed or refractory gestational trophoblastic neoplasia treated with etoposide and cisplatin/etoposide, methotrexate, and actinomycin D (EP-EMA) regimen. Int J Gynecol Oncol 2007, 98:44-47.
67. Newlands E.S., Mulholland P.J., Holden L., et al. Etoposide and cisplatin/etoposide, methotrexate and actinomycin D (EMA) for patients with high-risk gestational trophoblastic tumors refractory to EMA/cyclophosphamide and vincristine and patients presenting with metastatic placental site tumors. JClin Oncol 2000, 18:854-859.
68. Evans A.C., Soper J.T., Clarke-Pearson D.L., et al. Gestational trophoblastic disease metastatic to the central nervous system. Gynecol Oncol 1995, 59:226-230.
69. Small W., Lurain J.R., Shetty R.M., et al. Gestational trophoblastic disease metastatic to the brain. Radiology 1996, 200:277-280.
70. Rustin G.J., Newlands E.S., Begent R.H., et al. Weekly alternating etoposide, methotrexate, and actinomycin/vincristine and cyclophosphamide chemotherapy for the treatment of CNS metastases of choriocarcinoma. JClin Oncol 1989, 7:900-903.
71. Bakri Y.N., Berkowitz R.S., Goldstein D.P., et al. Brain metastases of gestational trophoblastic tumor. JReprod Med 1994, 39:179-184.
72. Newlands E.S., Holden L., Seckl M.J., et al. Management of brain metastases in patients with high risk gestational trophoblastic tumors. JReprod Med 2002, 47:465-471.
73. Tomoda Y., Arii Y., Kaseki S., et al. Surgical indications for resection in pulmonary metastases of choriocarcinoma. Cancer 1980, 46:2723-2730.
74. Fleming E.L., Garrett L.A., Growdon W.B., et al. The changing role of thoracotomy in gestational trophoblastic neoplasia at the New England Trophoblastic Disease Center. JReprod Med 2008, 53:493-498.
75. Edwards J.L., Makey A.R., Bagshawe K.D. The role of thoracotomy in the management of pulmonary metastases of gestational choriocarcinoma. Clin Oncol 1975, 1:329-339.
76. Shirley R.L., Goldstein D.P., Collins J.J. The role of thoracotomy in management of patients with chest metastases from gestational trophoblastic disease. JThorac Cardiovasc Surg 1972, 63:545-550.
77. Wang Y., Song H.Z., Xia Z. Drug resistant pulmonary choriocarcinoma metastasis treated by lobectomy. Chin Med J 1980, 93:758-766.
78. Sink J.D., Hammond C.B., Young W.G. Pulmonary resection in the management of metastases from choriocarcinoma. JThorac Cardiovasc Surg 1981, 81:830-834.
79. Wong L.C., Choo J.C., Ma H.K. Hepatic metastases in gestational trophoblastic disease. Obstet Gynecol 1986, 67:107-111.
80. Bakri Y.N., Subhi J., Amer M., et al. Liver metastases of gestational trophoblastic tumor. Gynecol Oncol 1993, 48:110-113.
81. Tse K.Y., Chan K.K., Tam K.F., et al. 20-year experience of managing profuse bleeding in gestational trophoblastic disease. JReprod Med 2007, 52:397.
82. Grumbine F.C., Rosenshein N.B., Brereton H.D., et al. Management of liver metastases from gestational trophoblastic neoplasia. Am J Obstet Gynecol 1980, 137:959-961.
83. Yang J., Xiang Y., Wan X., et al. Recurrent gestational trophoblastic tumor: management and risk factors for recurrence. Gynecol Oncol 2006, 103:587-590.
84. Ngan H.Y., Tam K.F., Lam K.W., et al. Relapsed gestational trophoblastic neoplasia: a 20-year experience. JReprod Med 2006, 51:829-834.
85. Powles Y., Savage P.M., Stebbing J., et al. Acomparison of patients with relapsed and chemo-refractory gestational trophoblastic neoplasia. Br J Cancer 2007, 96:732-737.
86. Mutch D.G., Soper J.T., Babcock C.J., et al. Recurrent gestational trophoblastic disease. Experience of the Southeastern Regional Trophoblastic Disease Center. Cancer 1990, 66:978-982.
87. Osborne R., Covens A., Merchandani D.E., et al. Successful salvage of relapsed high-risk gestational trophoblastic neoplasia patients using a novel paclitaxel-containing doublet. JReprod Med 2004, 49:655-661.
88. Wang J., Short D., Sebire J., et al. Salvage chemotherapy of relapsed or high- risk gestational trophoblastic neoplasia (GTN) with paclitaxel/cisplatin alternating with paclitaxel/etoposide(TP/TE). Ann Oncol 2008, 19:1578-1583.
89. Wan X., Yang Y., Wu Y., et al. Floxuridine-containing regimens in the treatment of gestational trophoblastic tumor. JReprod Med 2004, 49:453-456.
90. Matsui H., Iitsuka Y., Suzuka K., et al. Salvage chemotherapy for high-risk gestational trophoblastic tumor. JReprod Med 2004, 49:438-442.
91. Gordon A.N., Kavanagh J.J., Gershenson D.M., et al. Cisplatin, vinblastine, and bleomycin combination chemotherapy in resistant gestational trophoblastic disease. Cancer 1986, 58:1407-1410.
92. DuBeshter B., Berkowitz R.S., Goldstein D.P., et al. Vinblastine, cisplatin and bleomycin as salvage therapy for refractory high-risk metastatic gestational trophoblastic disease. JReprod Med 1989, 34:189-192.
93. Azab M., Droz J.P., Theodore C., et al. Cisplatin, vinblastine and bleomycin combination in the treatment of resistant high-risk gestational trophoblastic tumors. Cancer 1989, 64:1829-1832.
94. Sutton G.P., Soper J.T., Blessing J.A., et al. Ifosfamide alone and in combination in the treatment of refractory malignant gestational trophoblastic disease. Am J Obstet Gynecol 1992, 167:489-495.
95. Jones W.B., Schneider J., Shapiro F., et al. Treatment of resistant gestational trophoblastic choriocarcinoma with taxol: a report of two cases. Gynecol Oncol 1996, 61:126-130.
96. Giacalone P.L., Benos P., Donnadio D., et al. High-dose chemotherapy with autologous bone marrow transplantation for refractory metastatic gestational trophoblastic disease. Gynecol Oncol 1995, 58:383-385.
97. Van Besien K., Verschraegen C., Mehra R., et al. Complete remission of refractory gestational trophoblastic disease with brain metastases treated with multicycle ifosfamide, carboplatin, and etoposide (ICE) and stem cell rescue. Gynecol Oncol 1997, 65:366-369.
98. Tewari K.S., Monk B.J. American Society of Clinical Oncology 2011 Annual Meeting Update: Summary of selected gynecologic cancer abstracts. Gynecol Oncol 2011, 122:211-212.
99. Hoekstra A.V., Lurain J.R., Rademaker A.W., et al. Gestational trophoblastic neoplasia: treatment outcomes. Obstet Gynecol 2008, 112:251-258.
100. Cagayan M.S., Suyen Magallanes M. The role of adjuvant surgery in the management of gestational trophoblastic neoplasia. JReprod Med 2008, 53:513-518.
101. Clark R., Nevadunsky N., Ghosh E., et al. The evolving role of hysterectomy in gestational trophoblastic neoplasia at the New England Trophoblastic Disease Center. JReprod Med 2010, 55:194-198.
102. Lurain J.R., Singh D.K., Schink J.C. Role of surgery in the management of high-risk gestational trophoblastic neoplasia. JReprod Med 2006, 51:773-776.
103. Yingna S., Yang X., Xiuyu Y., et al. Clinical characteristics and treatment of gestational trophoblastic tumor and vaginal metastasis. Gynecol Oncol 2002, 84:416-419.
104. Feltmate C.M., Genest D.R., Goldstein D.P., et al. Advances in the understanding of placental site trophoblastic tumor. JReprod Med 2002, 47:337-341.
105. Palmer J.E., Macdonald M., Wells M., et al. Epithelioid trophoblastic tumor: a review of the literature. JReprod Med 2008, 53:465-475.
106. Papadopoulos A.J., Foskett M., Seckl M.J., et al. Twenty- five years' clinical experience with placental site trophoblastic tumors. JReprod Med 2002, 47:460-464.
107. Hassaida A., Gillespie A., Tidy J. Placental site trophoblastic tumor: clinical features and management. Gynecol Oncol 2005, 99:603-607.
108. Schmid P., Nagai Y., Agarwal R., et al. Prognostic markers and long-term outcome of placental-site trophoblastic tumors: a retrospective observational study. Lancet 2009, 374:48-55.
109. Khanlian S.A., Cole L.A. Management of gestational trophoblastic disease and other cases with low serum levels of human chorionic gonadotropin. JReprod Med 2006, 51:812-818.
110. Cole L.A., Yasushi S., Muller C.Y. Normal production of human chorionic gonadotropin in menopause. NEngl J Med 2007, 356:1184-1186.
111. Cole L.A., Butler S. Detection of hCG in trophoblastic disease. The USA hCG Reference Service experience. JReprod Med 2002, 47:433-444.
112. Cole L.A., Kohorn E.I. The need for an hCG assay that appropriately detects trophoblastic disease and other hCG- producing tumors. JReprod Med 2006, 51:793-811.
113. Kohorn E.I. What we know about low-level hCG: definition, classification and management. JReprod Med 2004, 49:433-437.
114. Hwang D., Hancock B.W. Management of persistent, unexplained, low-level human chorionic gonadotropin elevation: a report of 5 cases. JReprod Med 2004, 49:559-562.
115. Garrett L.A., Garner E.I., Feltmate C.M., et al. Subsequent pregnancy outcomes in patients with molar pregnancy and persistent gestational trophoblastic neoplasia. JReprod Med 2008, 53:481-486.
116. Ayhan A., Ergeneli M.H., Yuce K., et al. Pregnancy after chemotherapy for gestational trophoblastic disease. JReprod Med 1990, 35:522-524.
117. Kim J.H., Park D.C., Bae S.N., et al. Subsequent reproductive experience after treatment for gestational trophoblastic disease. Gynecol Oncol 1998, 71:108-112.
118. Kjer J.J., Iversen T. Malignant trophoblastic tumors in Norway: fertility rate after chemotherapy. Br J Obstet Gynaecol 1990, 97:623-625.
119. Kobayashi O., Matsui H., Takamizawa H. Analysis of pregnancy outcome after chemotherapy for trophoblastic disease. Nippon Sanka Fujinka Gakkai Zasshi 1986, 38:181-186.
120. Ngan H.Y.S., Wong L.C., Ma H.K. Reproductive performance of patients with gestational trophoblastic disease in Hong Kong. Acta Obstet Gynecol Scand 1988, 67:11-14.
121. Song H.Z., Wu P.C., Wang Y., et al. Pregnancy outcome after successful chemotherapy for choriocarcinoma and invasive mole: long-term follow-up. Am J Obstet Gynecol 1988, 158(3 Pt 1):538-545.
122. Woolas R.P., Bower M., Newlands E.S., et al. Influence of chemotherapy for gestational trophoblastic disease on subsequent pregnancy outcome. Br J Obstet Gynaecol 1998, 105:1032-1035. 9:1326-7.
123. Matsui H., Iitsuka Y., Suzuka K., et al. Early pregnancy outcome after chemotherapy for gestational trophoblastic tumor. JReprod Med 2004, 49:531-534.
124. Wenzel L., Berkowitz R.S., Newlands E., et al. Quality of life after gestational trophoblastic disease. JReprod Med 2002, 47:387-394.
125. Cagayan M.S., Llarena R.T. Quality of life of gestational neoplasia survivors: a study of patients at the Philippine General Hospital Trophoblastic Disease Section. JReprod Med 2010, 55:321-326.