Support for low-risk GTNs

SOGC/GOC Clinical Guideline #408, January 2021

The primary chemotherapies used as monotherapy in the treatment of low-risk GTN are methotrexate and dactinomycin.
Debate persists regarding the most effective chemotherapy protocol taking into account primary cure rate, patient comfort and quality of life, adverse effect profile, and cost.
It is possible to offer hysterectomy to stage I patients who do not wish to have any more pregnancies: 82% will not need salvage chemotherapy
It is possible to offer a second curettage to patients ≤ 35 years old with a score of ≤ 4: 40% will not need salvage chemotherapy and low risk of uterine perforation or acute bleeding, unknown risk on fertility (uterine synechia).
Quantitative serum hCG levels should be monitored on a weekly basis to rapidly detect the development of resistant disease.
An assay capable of detecting all forms of hCG (eg, ß-hCG, ß-core fragment, C-terminal extension, cleaved free ß subunit, ß-core) should be used.
In addition, it is recommended to use the same laboratory each time to avoid discrepancies in results.
Consolidation chemotherapy after normalization of serum hCG level continues for 4-6 weeks (2-3 cycles).
The overall cure rate is approaching 100%.

2021. Guideline No. 408: Management of Gestational Trophoblastic Diseases. Eiriksson L, Dean E, Sebastianelli A, Salvador S, Comeau R, Jang JH, Bouchard-Fortier G, Osborne R, Sauthier Ph. J Obstet Gynaecol Can;43(1):91-105.

Modified on 12/22/2023