DIAGNOSIS AND THERAPEUTICS OF GESTATIONAL TROPHOBLASTIC DISEASE: CURRENT PERSPECTIVES (Atena Editora)

Abstract

Introduction: Gestational Trophoblastic Disease (GTD) represents a group of conditions characterized by abnormal proliferation of placental trophoblasts. The main type is the Hydatidiform Mole (MH). DTG can evolve into invasive neoplasia, where 25% of cases resist chemotherapy treatment. Diagnosing these conditions early is essential for a better prognosis and maintenance of the reproductive capacity of affected patients. This work presents a focus on the diagnostic approach and therapeutic strategies of DTG. Methodology: review article based preferably on works published in the last 5 years in the MEDLINE, LILACS and SciELO databases, in Portuguese and English, using the descriptor “gestational trophoblastic disease” and the combined descriptors: hydatidiform mole, pregnancy and management. Works that did not fit into the delimited time frame or topic addressed were excluded. Literature Review: Early diagnosis of GTD, established by specific ultrasound criteria and high hCG titers, allows complete resolution of the condition. Late diagnosis requires more aggressive therapy, with a worse prognosis. In addition to uterine emptying, post-molar follow-up with serum hCG measurement is recommended, and staging of post-molar GTD must be performed with pelvic-transvaginal Doppler ultrasound and chest radiography. In lung metastases larger than 1 cm, chest computed tomography and brain magnetic resonance imaging must be requested. Monochemotherapy, generally using methotrexate (MTX) or actinomycin-D (Act-D), cures around 70% of low-risk patients, with polychemotherapy being reserved, such as the Etoposide, MTX, Act-D, Cyclophosphamide and Oncovin, for high-risk cases, generally metastatic. Conclusion: Even though the recognition of this condition is low cost and can be carried out from the first half of pregnancy, delay in diagnosing GTD increases maternal morbidity and mortality, reduces chances of cure and makes it difficult to maintain women's reproductive potential. affected.