Highlights
- •GTD is rare and treatment protocols vary within Europe.
- •The European Organisation for treatment of GTD aims to harmonise treatment.
- •Clinical guidelines were formulated by consensus and based on available literature.
- •Flow diagrams were created for easy clinical use.
- •New definitions of recurrence and chemotherapy resistance were formulated.
Abstract
Background and aim
Gestational trophoblastic disease (GTD) is a heterogeneous group of disorders characterised
by abnormal proliferation of trophoblastic tissue. Since GTD and its malignant sequel
gestational trophoblastic neoplasia (GTN) are rare diseases, little evidence is available
from randomised controlled trials on optimal treatment and follow-up. Treatment protocols
vary within Europe, and even between different centres within countries. One of the
goals of the ‘European Organisation for Treatment of Trophoblastic Diseases’ (EOTTD)
is to harmonise treatment in Europe. To provide a basis for European standardisation
of definitions, treatment and follow-up protocols in GTD, we composed a set of guidelines
for minimal requirements and optimal management of GTD.
Methods
Members from each EOTTD country attended multiple workshops during annual EOTTD meetings.
Clinical guidelines were formulated by consensus and evidence where available. The
following guidelines were discussed: diagnostics of GTD and GTN, treatment of low-risk
GTN, high-risk GTN, ultra-high-risk GTN, placental site and epithelioid trophoblastic
tumours and follow-up.
Results
Between 40 and 65 EOTTD members from 17 European countries and 7 non-European countries
attended the clinical workshops held on 6 occasions. Flow diagrams for patient management
were composed to display minimum and best practice for most treatment situations.
New agreed definitions of recurrence and chemotherapy resistance were formulated.
Conclusions
Despite the many differences between and within the participating countries, an important
step in uniform treatment of GTD and GTN within Europe was made by the Clinical Working
Party of the EOTTD. This is an example on how guidelines and harmonisation can be
achieved within international networks.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: April 01, 2020
Accepted:
February 4,
2020
Received in revised form:
January 29,
2020
Received:
November 15,
2019
Identification
Copyright
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