Diagnosis and management of gestational trophoblastic disease: 2025 update

Gestational trophoblastic disease (GTD) arises from abnormal placenta and comprises a spectrum of premalignant to malignant disorders. Changes in the epidemiology of GTD have been noted in various countries. In addition to histology, molecular genetic studies can help in the diagnostic pathway. Earlier detection of molar pregnancy by ultrasound has resulted in changes in clinical presentation and decreased morbidity from uterine evacuation. Follow-up with human chorionic gonadotropin (hCG) is essential for early diagnosis of gestational trophoblastic neoplasia (GTN). The duration of hCG monitoring varies depending on histological type and regression rate. Low-risk GTN (International Federation of Gynecology and Obstetrics [FIGO] Stages I-III: score <7) is treated with single-agent chemotherapy but may require additional agents. Although scores of 5-6 are associated with higher drug resistance, overall survival approaches 100%. High-risk GTN (FIGO Stages II-III: score >= 7 and Stage IV) is treated with multi-agent chemotherapy, with or without adjuvant surgery for excision of resistant foci of disease or radiotherapy for brain metastases, achieving a survival rate of approximately 90%. Gentle induction chemotherapy in ultra-high-risk disease helps reduce early deaths in patients with extensive tumor burden, but late mortality still occurs from recurrent treatment-resistant tumors. Immunotherapy can be considered in recurrence.