Approches cliniques et thérapeutiques des maladies trophoblastiques

The diagnosis of gestational trophoblastic tumors (GTT) (hydatiform mole, invasive mole, choriocarcinoma, placental-site trophoblastic tumor) is suggested by gynecological symptoms, elevated hCG long after a pregnancy or through detection of a metastasis. The diagnosis is based on histological sample and/or an elevated hCG level. As the specificity and sensitivity of plasma hCG determinations -are very high, hCG and β-hCG determinations are of paramount importance for the initial diagnosis, and during follow-up (during and after treatment). Chemotherapy has totally transformed the prognosis of GTT but within this group coexist tumors with differing prognosis. Several studies have identified diverse prognostic factors. Various classifications are described, but none is universal. Once the diagnosis is made, patients undergo clinical, biological and radiological examinations to determine the prognosis. So, treatment can be tailored to fit each case (chemotherapy or not, protocol of chemotherapy, surgery or not). Efficient contraception must be prescribed throughout the duration of treatment and during follow up. Another pregnancy can be allowed 6 months after a good prognosis GTT and 1 year after a poor prognosis GTT.