The French National Reference Centre of GTD
The French National Reference Centre of GTD
The French Gestational Trophoblastic Disease (GTD) centre has been set up and active by
 registering, monitoring and treating women with GTD since november 1999. The aim is to
 improve the management of trophoblastic disease in France.

 About 850 new cases are registered each year and 140 women treated, mostly with chemotherapy
 and surgery.

 The center works as follow, based on a multidisciplinary approach. The policy is that patient
 remains followed by her local physician, but can be seen and treated in the Center at demand
 and that the registry is done on a voluntary basis.

 Each administrative french area has a local expert team (oncologist and gynaecologist) who is
 able to look after the patients with the help of the national reference center physicians
 based in Lyon.

 -  Once a doctor discovers a molar pregnancy, he contacts the center, with the agreement of
 his patient, for an opinion, an advice or simply to report the case.

 -  The center sends to the doctor the informed consent form to be signed by the patient, a
 registering form and information about pathology for patient and physician, and first
 guidelines based on initial pathology report.

 The patient remains followed by her gynecologist, who stays her first interlocutor throughout
 the whole process and she goes to her local laboratory for hCG monitoring;

 -  A letter is sent to the initial pathology laboratory that originally carried the
 diagnosis of molar pregnancy to require slide sending to the pathologist referral center
 (9 experts with a specific pathologist national network) that centrally review initial
 diagnosis.

 -  In the mean time, the data manager collects weekly hCG values to establish a follow-up
 chart. The physician is regularly informed by mail of the hCG evolution.

 -  The local physician is contacted in case of modification of the diagnosis by the
 pathologist expert. The center informs him about length and monitoring methodology.

 -  Emails or letters are sent at each step of the management (at inclusion, at hCG
 negativation, and at the end of hCG follow-up).

 -  In case of abnormal hCG evolution (raise, plateauing or positivity at 6 months,) or if a
 neoplasia is anatomopathologically diagnosed (choriocarcinoma, PSTT or ETT), physician
 is immediately contacted by phone or email by referent gynaecologist. A complete work up
 including pelvic US with Doppler, pelvic MRI, thoraco-abdominal CT-scan with chest
 radiography if pulmonary nodules are present and brain MRI, is planned to determine the
 adequate treatment.

 Very briefly, based on imaging results, FIGO stade and score are calculated to determine the
 risk. In case of low-risk, a monochemotherapy is settled, while a polychemotherapy is started
 in case of high-risk disease.

 The investigators have developped specific expertise at key levels of diagnosis, management,
 follow-up, fertility preservation and treatment.

 Assignments :

 -  Registration and monitoring post diagnosis of complete or partial molar pregnancy,
 choriocarcinoma,PSTT, ETT, atypical placental site nodules

 -  Histopathological analysis and genetics services

 -  Measurement of human chorionic gonadotrophin (hCG) isoforms

 -  Complex gynaecological surgery
Inclusion Criteria:

 -  Patients are eligible if they have a histologically proven trophoblastic disease, or a
 diagnosis of gestational trophoblastic neoplasia done on an abnormal evolution of hCG

 Exclusion Criteria:

 -  none