Radiation Therapy for Gestational Trophoblastic Neoplasia: Forward-Looking Lessons Learnt

Simple Summary The management of high-risk gestational trophoblastic neoplasia is multimodal, requiring a multimodality treatment that might include radiotherapy, especially in high-risk metastatic settings. The recent NCCN guidelines suggest considering whole-brain irradiation or stereotactic radiotherapy, with or without intrathecal methotrexate, for high-risk gestational trophoblastic neoplasia patients with brain metastases. However, there is little consensus regarding the indication and role of radiotherapy for the extra-central nervous system localizations such as lung, liver and vaginal. The haemorrhagic tendency justifies the haemostatic role of radiotherapy, but on the other hand, the high rate of necrosis is a radioresistance hallmark that requires great attention in terms of fractionation schedules and radiation type. Due to the rarity of this disease and the non-routine use of radiotherapy in metastatic settings prospective randomized trials are unrealistic. In this narrative review, we discuss the data about the past and current roles and indications of radiotherapy concerning these patients to potentially help physicians in treating these challenging clinical presentations.Abstract Gestational trophoblastic neoplasia (GTN) includes several rare malignant diseases occurring after pregnancy: invasive moles, choriocarcinoma, placental site trophoblastic tumours, and epithelioid trophoblastic tumours. Multidisciplinary protocols including multi-agent chemotherapy, surgery, and occasionally radiotherapy achieve good outcomes for some high-risk metastatic patients. In this narrative review of the published studies on the topic, we have tried to identify the role of radiotherapy. The available studies are mainly small, old, and retrospective, with incomplete data regarding radiotherapy protocols delivering low doses (which can make this disease appear radioresistant in some cases despite high response rates with palliative doses) to wide fields (whole-brain, whole-liver, etc.), which can increase toxicity. Studies considering modern techniques are needed to overcome these limitations and determine the full potential of radiotherapy beyond its antihemorrhagic and palliative roles.

Automated summary

The management of high-risk gestational trophoblastic neoplasia requires a multimodality treatment that may include radiotherapy. There is little consensus on the indication and role of radiotherapy for extra-central nervous system localizations. Radiotherapy can have a hemostatic role, but the high rate of necrosis requires attention to fractionation schedules and radiation type.