Information for Clinicians

Charing Cross Hospital (CXH) Trophoblast Disease Clinic Guide

Publications

GTT Scientific and Clinical Publications

The GTT unit at Charing Cross Hospital has been closely involved in developing the treatment of GTT. We have listed below the most recent publications along with their PubMed links. Also lower down the page are some of the key historical publications from Charing Cross that have helped develop the current successful management of GTT.

Historical Interest

Bagshawe KD Risk and prognostic factors in trophoblastic neoplasia Cancer. 1976 Sep;38(3):1373-85

Bagshawe KD, Dent J, Webb J Hydatidiform mole in England and Wales 1973-83 Lancet. 1986 Sep 20;2(8508):673-7

Reviews

Seckl MJ, Sebire NJ and Berkowitz R (2010) Gestational trophoblastic disease. Lancet 2010 Aug 28;376(9742):717-29.

Seckl MJ, Sebire NJ, Fisher RA, Golfier F, Massuger L, Sessa C; ESMO Guidelines Working Group (2013) Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013 Oct;24 Suppl 6:vi39-50

Diagnosis

Agarwal R, Teoh S, Short D, Harvey R, Savage PM, Seckl MJ (2012) Elevated human chorionic gonadotrophon levels six months after uterine evacuation of molar pregnancy- is chemotherapy necessary? A retrospective cohort study. Lancet Mar 13;106(6):1089-94

Fisher RA, Savage PM, MacDermott C, Hook J, Sebire NJ, Lindsay I, Seckl MJ (2007) The impact of molecular genetic diagnosis on the management of women with hCG-producing malignancies. Gynaecol Oncol. 2007 Dec;107(3):413-9

Harvey RA, Mitchell HDC, Stenman U-H, Blankenstein MA, Nustad K, Stieber P, Stewart W, Savage PM, Seckl MJ, Braunstein GD (2010) Differences in total human chorionic gonadotrophin (hCG) immunoassays’ analytical specificity and ability to measure hCG from gestational trophoblastic disease and germ cell tumour patients. J Reprod Med 2010 Jul-Aug;55(7-8):285-95

Kaur B, Short D, Fisher RA, Savage PM, Seckl MJ, Sebire NJ. Atypical Placental Site Nodule (APSN) and Association With Malignant Gestational Trophoblastic Disease; A Clinicopathologic Study of 21 Cases. Int J Gynecol Pathol. 2015 Mar;34(2):152-8

Openshaw MR, Harvey RA, Sebire NJ, Kaur B, Sarwar N, Seckl MJ, Fisher RA. Circulating Cell Free DNA in the Diagnosis of Trophoblastic Tumors. EBioMedicine. 2015 Dec 29;4:146-52.

Paradinas FJ The diagnosis and prognosis of molar pregnancy: the experience of the National Referral Centre in London Int J Gynaecol Obstet. 1998 Apr;60 Suppl 1:S57-64

Demographics

Savage PM, Sita-Lumsden A, Dickson S, Iyer R, Everard J, Coleman R, Fisher RA, Short D, Casalboni S, Catalano K, Seckl MJ (2013)  The relationship of maternal age to molar pregnancy incidence, risks for chemotherapy and subsequent pregnancy outcome. J Obstet Gynaecol. 2013 May;33(4):406-11

Sebire NJ, Foskett M, Fisher RA, Rees H, Seckl M, Newlands E. Risk of partial and complete hydatidiform molar pregnancy in relation to maternal age BJOG. 2002 Jan;109(1):99-102

Sebire NJ, Fisher RA, Foskett M, Rees H, Seckl MJ, Newlands ES. Risk of recurrent hydatidiform mole and subsequent pregnancy outcome following complete or partial hydatidiform molar pregnancy. BJOG. 2003 Jan;110(1):22-6

Sebire NJ, Foskett M, Paradinas FJ, Fisher RA, Francis RJ, Short D, Newlands ES, Seckl MJ. Outcome of twin pregnancies with complete hydatidiform mole and healthy co-twin. Lancet. 2002 Jun 22;359(9324):2165-6

Low Risk Disease

Bagshawe KD, Dent J, Newlands ES, Begent RH, Rustin GJ. The role of low-dose methotrexate and folinic acid in gestational trophoblastic tumours (GTT) Br J Obstet Gynaecol. 1989 Jul;96(7):795-802

Lybol C, Sweep FC, Harvey R, Mitchell H, Short D, Thomas CM, Ottevanger PB, Savage PM, Massuger LF, Seckl MJ (2012) Relapse rates after two versus three consolidation courses of methotrexate in the treatment of low-risk gestational trophoblastic neoplasia. Gynecol Oncol. Jun;125(3):576-9

McNeish IA, Strickland S, Holden L, Rustin GJ, Foskett M, Seckl MJ, Newlands ES Low-risk persistent gestational trophoblastic disease: outcome after initial treatment with low-dose methotrexate and folinic acid from 1992 to 2000. J Clin Oncol. 2002 Apr 1;20(7):1838-44

Savage P, Seckl MJ. The role of repeat uterine evacuation in trophoblast disease. Gynecol Oncol. 2005 Oct;99(1):251-2

Sita-Lumsden A, Short D, Lindsay I, Sebire NJ, Adjogatse D, Seckl MJ, Savage PM (2012) Treatment outcomes for 618 women with gestational trophoblastic tumours following a molar pregnancy at the Charing Cross Hospital, 2000-2009. Br J Cancer. 2012 Nov 20;107(11):1810-4

High Risk Disease

Ahamed E, Short D, North B, Savage PM, Seckl MJ (2012) Survival of women with gestational trophoblastic neoplasia and liver metastases: is it improving? J Reprod Med. 2012 May-Jun;57(5-6):262-9

Alifrangis C, Agarwal R, Short D, Fisher RA, Sebire NJ, Harvey R, Savage PM, Seckl MJ. (2013) EMA/CO for high-risk gestational trophoblastic neoplasia: good outcomes with induction low-dose etoposide-cisplatin and genetic analysis.  J Clin Oncol; 31(2):280-6

Bower M, Newlands ES, Holden L, Short D, Brock C, Rustin GJ, Begent RH, Bagshawe KD EMA/CO for high-risk gestational trophoblastic tumors: results from a cohort of 272 patients J Clin Oncol. 1997 Jul;15(7):2636-43

El-Helw LM, Seckl MJ, Haynes R, Evans LS, Lorigan PC, Long J, Kanfer EJ, Newlands ES, Hancock BW. High-dose chemotherapy and peripheral blood stem cell support in refractory gestational trophoblastic neoplasia. Br J Cancer. 2005 Sep 19;93(6):620-1

Newlands ES, Bagshawe KD, Begent RH, Rustin GJ, Holden L Results with the EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) regimen in high risk gestational trophoblastic tumours, 1979 to 1989. Br J Obstet Gynaecol. 1991 Jun;98(6):550-7

Wang J, Short D, Sebire NJ, Lindsay I, Newlands ES, Schmid P, Savage PM, Seckl MJ (2007) Salvage chemotherapy of relapsed or high-risk gestational trophoblastic neoplasia (GTN) with paclitaxel/cisplatin alternating with paclitaxel/etoposide (TP/TE). Ann  Oncol. 2008 Sep;19(9):1578-83

CNS Metastases

Newlands ES, Holden L, Seckl MJ, McNeish I, Strickland S, Rustin GJ. Management of brain metastases in patients with high-risk gestational trophoblastic tumors J Reprod Med. 2002 Jun;47(6):465-71

Savage P, Kelpanides I, Tuthill M, Short D, Seckl MJ. Brain metastases in gestational trophoblast neoplasia: An update on incidence, management and outcome. Gynecol Oncol. 2015 Jan 15.

PSTT

Newlands ES, Mulholland PJ, Holden L, Seckl MJ, Rustin GJ Etoposide and cisplatin/etoposide, methotrexate, and actinomycin D (EMA) chemotherapy for patients with high-risk gestational trophoblastic tumors refractory to EMA/cyclophosphamide and vincristine chemotherapy and patients presenting with metastatic placental site trophoblastic tumors J Clin Oncol. 2000 Feb;18(4):854-9

Palmieri C, Fisher RA, Sebire NJ, Lindsay I, Smith JR, McGluggage WG, Savage P, Seckl MJ (2005) Placental site trophoblastic tumour arising from a partial hydatidiform mole: the importance of hCG surveillance. Lancet 366; 688

Papadopoulos AJ, Foskett M, Seckl MJ, McNeish I, Paradinas FJ, Rees H, Newlands ES Twenty-five years' clinical experience with placental site trophoblastic tumors J Reprod Med. 2002 Jun;47(6):460-4

Pfeffer PE, Sebire N, Lindsay I, McIndoe A, Lim A, Seckl MJ (2007) Fertility-sparing partial hysterectomy for placental-site trophoblastic tumour. Lancet Oncol Aug;8(8):744-6

Schmid P, Nagai Y, Agarwal R, Hancock BW, Savage PM, Sebire NJ, Lindsay I, Wells M, Fisher RA, Short D, Newlands ES, Wischnewsky MB, Seckl MJ (2009)  Prognostic markers and long-term outcome of placental-site trophoblastic tumours: a retrospective observational study. Lancet 2009  Jul 4;374(9683):6-7

Genetics of GTT

Fisher RA, Newlands ES Jeffreys AJ et al (1992). Gestational and non-gestational trophoblastic tumours distinguished by DNA analysis. British Journal of Cancer 69: 839-845

Fisher RA, Khatoon R, Paradinas FJ, Roberts AP, Newlands ES. Repetitive complete hydatidiform mole can be biparental in origin and either male or female. Hum Reprod. 2000 Mar;15(3):594-8

Fisher RA, Tommasi A, Short D, Kaur B, Seckl MJ, Sebire NJ. Clinical utility of selective molecular genotyping for diagnosis of partial hydatidiform mole; a retrospective study from a regional trophoblastic disease unit. J Clin Pathol. 2014 Nov;67(11):980-4

Paradinas FJ & Fisher RA (1995). Pathology and molecular genetics of trophoblastic disease. Current Obstetrics & Gynaecology (1995) 5, 6-12

Imaging in GTT

Dhillon T, Palmieri C, Sebire NJ, Lindsay I, Newlands ES, Schmid P, Savage PM, Frank J, Seckl MJ. Value of whole body 18FDG-PET to identify the active site of gestational trophoblastic neoplasia. J Reprod Med. 2006 Nov;51(11):879-87

Fowler DJ, Lindsay I, Seckl MJ, Sebire NJ. Routine pre-evacuation ultrasound diagnosis of hydatidiform mole: experience of more than 1000 cases from a regional referral center. Ultrasound Obstet Gynecol. 2006 Jan;27(1):56-60

Lim AK, Agarwal R, Seckl MJ, Newlands ES, Barrett NK, Mitchell AW. Embolization of bleeding residual uterine vascular malformations in patients with treated gestational trophoblastic tumors. Radiology. 2002 Mar;222(3):640-4

Sita-Lumsden A, Medani H, Fisher R, Harvey R, Short D, Sebire N, Savage P, Lim A, Seckl MJ, Agarwal R (2013).Uterine artery pulsatility index improves prediction of methotrexate resistance in women with gestational trophoblastic neoplasia with FIGO score 5-6. BJOG. 2013 Jul;120(8):1012-5.

Long Term Follow-Up

Blagden SP, Foskett MA, Fisher RA, Short D, Fuller S, Newlands ES, Seckl MJ. The effect of early pregnancy following chemotherapy on disease relapse and foetal outcome in women treated for gestational trophoblastic tumours. Br J Cancer. 2002 Jan 7;86(1):26-30

Bower M, Rustin GJ, Newlands ES, Holden L, Short D, Foskett M, Bagshawe KD Chemotherapy for gestational trophoblastic tumours hastens menopause by 3 years Eur J Cancer. 1998 Jul;34(8):1204-7

Rustin GJ, Newlands ES, Lutz JM, Holden L, Bagshawe KD, Hiscox JG, Foskett M, Fuller S, Short D Combination but not single-agent methotrexate chemotherapy for gestational trophoblastic tumors increases the incidence of second tumors J Clin Oncol. 1996 Oct;14(10):2769-73

Savage P, Cooke R, O'Nions J, Krell J, Kwan A, Camarata M, Dancy G, Short D, Seckl MJ, Swerdlow A. Effects of single-agent and combination chemotherapy for gestational trophoblastic tumors on risks of second malignancy and early menopause. J Clin Oncol. 2015 Feb 10;33(5):472-8.

Wenzel L, Berkowitz RS, Newlands E, Hancock B, Goldstein DP, Seckl MJ, Habbal R, Bernstein M, Kluhsman B, Kulchak-Rahm A, Strickland S, Higgins J Quality of life after gestational trophoblastic disease J Reprod Med. 2002 May;47(5):387-94.

Williams J, Short D, Dayal L, Strickland S, Harvey R, Tin T, Savage PM, Seckl MJ.  Effect of early pregnancy following chemotherapy on disease relapse and fetal outcome in women treated for gestational trophoblastic neoplasia. J Reprod Med. 2014 May-Jun;59(5-6):248-54

Woolas RP, Bower M, Newlands ES, Seckl M, Short D, Holden LWoolas RP, Bower M, Newlands ES, Seckl M, Short D, Holden L. Influence of chemotherapy for gestational trophoblastic disease on subsequent pregnancy outcome. Br J Obstet Gynaecol. 1998 Sep;105(9):1032-5

Recent Publications

Fisher RA, Lavery SA, Carby A, Abu-Hayyeh S, Swingler R, Sebire NJ, Seckl MJ (2011) What a difference an egg makes. Lancet Dec 3;378(9807):1974

Saso S, Haddad J, Ellis P, Lindsay I, Sebire NJ, McIndoe A, Seckl MJ, Smith JR (2012) Placental Site Trophoblastic Tumours and the Concept of Fertility Preservation. BJOG Feb;119(3):369-74

Agarwal R, Teoh S, Short D, Harvey R, Savage PM, Seckl MJ (2012) Elevated human chorionic gonadotrophon levels six months after uterine evacuation of molar pregnancy- is chemotherapy necessary? A retrospective cohort study. Lancet Mar 13;106(6):1089-94

Fisher RA, Tommasi A, Short D, Kaur B, Seckl MJ, Sebire NJ. Clinical utility of selective molecular genotyping for diagnosis of partial hydatidiform mole; a retrospective study from a regional trophoblastic disease unit. J Clin Pathol. 2014 Nov;67(11):980-4

Froeling FE, Seckl MJ. Gestational trophoblastic tumours: an update for 2014. Curr Oncol Rep. 2014 Nov;16(11):408

Mangili G, Lorusso D, Brown J, Pfisterer J, Massuger L, Vaughan M, Ngan HY, Golfier F, Sekharan PK, Charry RC, Poveda A, Kim JW, Xiang Y, Berkowtiz R, Seckl MJ. Trophoblastic disease review for diagnosis and management: a joint report from the International Society for the Study of Trophoblastic Disease, European Organisation for the Treatment of Trophoblastic Disease, and the Gynecologic Cancer InterGroup. Int J Gynecol Cancer. 2014 Nov;24(9 Suppl 3):S109-16

Seckl M. Time to stop offering prophylactic chemotherapy after molar pregnancies? BJOG. 2014 Oct;121(11):1420

Taylor F, Short D, Winter MC, Tidy J, Savage PM, Sarwar N, Hancock BW, Seckl MJ, Coleman RE. A retrospective study to evaluate single agent methotrexate treatment in low risk gestational choriocarcinoma in the United Kingdom. Gynecol Oncol. 2015 Feb;136(2):258-63.

Savage P, Cooke R, O'Nions J, Krell J, Kwan A, Camarata M, Dancy G, Short D, Seckl MJ, Swerdlow A. Effects of single-agent and combination chemotherapy for gestational trophoblastic tumors on risks of second malignancy and early menopause. J Clin Oncol. 2015 Feb 10;33(5):472-8.

Savage P, Kelpanides I, Tuthill M, Short D, Seckl MJ. Brain metastases in gestational trophoblast neoplasia: An update on incidence, management and outcome. Gynecol Oncol. 2015 Jan 15.

Kaur B, Short D, Fisher RA, Savage PM, Seckl MJ, Sebire NJ. Atypical Placental Site Nodule (APSN) and Association With Malignant Gestational Trophoblastic Disease; A Clinicopathologic Study of 21 Cases. Int J Gynecol Pathol. 2015 Mar;34(2):152-8

Bolze PA, Attia J, Massardier J, Seckl MJ, Massuger L, van Trommel N, Niemann I, Hajri T, Schott AM, Golfier F; EOTTD group. Formalised consensus of the European Organisation for Treatment of Trophoblastic Diseases on management of gestational trophoblastic diseases. Eur J Cancer. 2015 Jun 16.

Ngan HY, Seckl MJ, Berkowitz RS, Xiang Y, Golfier F, Sekharan PK, Lurain JR. Update on the diagnosis and management of gestational trophoblastic disease. Int J Gynaecol Obstet. 2015 Oct;131 Suppl 2:S123-6.

Braga A, Maestá I, Short D, Savage P, Harvey R, Seckl MJ. Hormonal contraceptive use before hCG remission does not increase the risk of gestational trophoblastic neoplasia following complete hydatidiform mole: a historical database review. BJOG. 2015 Oct 7.

Taylor F, Short D, Harvey R, Winter MC, Tidy J, Hancock BW, Savage PM, Sarwar N, Seckl MJ, Coleman RE. Late spontaneous resolution of persistent molar pregnancy. BJOG. 2016 Jan 15.

Sebire NJ, May PC, Kaur B, Seckl MJ, Fisher RA. Abnormal villous morphology mimicking a hydatidiform mole associated with paternal trisomy of chromosomes 3,7,8 and unipaternal disomy of chromosome 11. Diagn Pathol. 2016 Feb 4;11(1):20.

Openshaw MR, Harvey RA, Sebire NJ, Kaur B, Sarwar N, Seckl MJ, Fisher RA. Circulating Cell Free DNA in the Diagnosis of Trophoblastic Tumors. EBioMedicine. 2015 Dec 29;4:146-52.

Jiao L, Ghorani E, Sebire NJ, Seckl MJ. Intraplacental choriocarcinoma: Systematic review and management guidance. Gynecol Oncol. 2016 Jun;141(3):624-31.

Eagles N, Sebire NJ, Short D, Savage PM, Seckl MJ, Fisher RA.  Risk of recurrent molar pregnancies following complete and partial hydatidiform moles. Hum Reprod. 2016 Jun;31(6):1379.

Zhao S, Sebire NJ, Kaur B, Seckl MJ, Fisher RA. Molecular genotyping of placental site and epithelioid trophoblastic tumours; female predominance. Gynecol Oncol. 2016 Sep;142(3):501-7

Tyebally S, Ghorani E, Kaur B, Sturdy A, Khokhar A, Fisher R, Seckl M, Price L A case of progressive breathlessness post partum. Thorax. 2016 Sep;71(9):871-2

Ghorani E, Ramaswami R, Smith RJ, Savage PM, Seckl MJ. Anti-Müllerian Hormone in Patients Treated with Chemotherapy for Gestational Trophoblastic Neoplasia Does Not Predict Short-Term Fertility. J Reprod Med. 2016 May-Jun;61(5-6):205-9

Li Y, Tang MX, Agarwal R, Patel D, Eckersley RJ, Barrois G, Roddie ME, Dayal L, Savage PM, Seckl MJ, Lim A. Power Doppler Quantification in assessing Gestational Trophoblastic Neoplasia. Ultraschall Med. 2016 Aug 16.

Eysbouts YK, Massuger L, Thomas C, Ottevanger P, Short D, Harvey R, Sebire N, Kaur B, Naveed S, Sweep F, Seckl M.   Dutch Risk Classification and FIGO 2000 for Gestational Trophoblastic Neoplasia Compared. Int J Gynecol Cancer. 2016 Nov;26(9):1712-1716

Web site designed by Paul Littlefield