Role of Radiotherapy in Gestational Trophoblastic Neoplasia: A Case Report

Arie Munandar; Viona Viona

doi:10.32532/jori.v13i1.143

Role of Radiotherapy in Gestational Trophoblastic Neoplasia: A Case Report

Arie Munandar, Viona Viona

Sari

Gestational trophoblastic neoplasia (GTN) is a placental tissues malignancy that is prone to massive bleeding. Multimodality treatment is often needed to treat GTN, such as surgery and radiotherapy. Radiotherapy has a palliative role in case of hemorrhage and/or intracranial metastases.

Radiotherapy is effective in controlling bleeding by destructing malignant blood vessels by inducing endothelial damage and increasing signal transduction pathway leading to apoptosis and increasing adhesion of thrombocytes to vascular endothelia resulting fibrosis. No dose and fractionation schemes are proven more effective than others, but longer fractions scheme (>5 fractions) and BED₁₀ > 39 Gy show no additional benefit in hemostatic control or in reduction of re-bleeding rate.

Brain metastatic lesions are prone to bleeding that might need craniotomy for blood evacuation or brain decompression. WBRT can be given concurrently with chemotherapy in brain metastatic GTN cases. Higher WBRT total dose (>22 Gy) associated with higher 5-year local control rates.

Kata Kunci

gestational trophoblastic neoplasia, radiotherapy, hemostatic radiation, whole brain radiotherapy

Teks Lengkap:

PDF (English)

Referensi

Shenoy S, Yadav R, Parikh A, Mehta M, Suryanarayan U. Haemostatic Radiotherapy Dosing Schedules: A Review Article.

Chaw CL, Niblock PG, Chaw CS, Adamson DJ. The role of palliative radiotherapy for haemostasis in unresectable gastric cancer: a single-institution experience. Ecancermedicalscience. 2014;8.

Johnstone C, Rich SE. Bleeding in cancer patients and its treatment: a review. Annals of palliative medicine. 2017 Dec 18;7(2):265-73.

Pereira J, Phan T. Management of bleeding in patients with advanced cancer. The oncologist. 2004 Sep;9(5):561-70.

Sapienza LG, Ning MS, Jhingran A, Lin LL, Leão CR, da Silva BB, de Assis Pellizzon AC, Gomes MJ, Baiocchi G. Short-course palliative radiation therapy leads to excellent bleeding control: A single centre retrospective study. Clinical and translational radiation oncology. 2019 Jan 1;14:40-6.

Soper JT. Role of surgery and radiation therapy in the management of gestational trophoblastic disease. Best Practice & Research Clinical Obstetrics & Gynaecology. 2003 Dec 1;17(6):943-57.

Evans Jr AC, Soper JT, Clarke-Pearson DL, Berchuck A, Rodriguez GC, Hammond CB. Gestational trophoblastic disease metastatic to the central nervous system. Gynecologic oncology. 1995 Nov 1;59(2):226-30.

Gavanier D, Leport H, Massardier J, Abbas F, Schott AM, Hajri T, Golfier F, Bolze PA. Gestational trophoblastic neoplasia with brain metastasis at initial presentation: a retrospective study. International journal of clinical oncology. 2019 Feb;24(2):153-60.

DOI: https://doi.org/10.32532/jori.v13i1.143 <