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1. Brazilian network for gestational trophoblastic disease study group consensus on management of gestational trophoblastic disease

Author

Braga, A., Souza, P. O., Dos Santos Esteves, A. P. V., Padrón, L., Uberti, E., Viggiano, M., Sun, S. Y., Izildinha Maestá, Elias, K. M., Horowitz, N., Berkowitz, R., Grillo, B., Botogoski, S. R., Madi, J. M., Cardoso, R. B., Costa, F. R. P., Filho, A. C., Filho, H. Z. B., Osanan, G. C., Gomes, D. A. Y., Lin, L. H., Pitorri, A., Silveira, E., Andrade, J. M., Sousa, C. B., Fernandes, K. G., Rezende-Filho, J., Junior, J. A., Cardoso, F. F. O., Asmar, F. T. C., Pesce, R. R. P., Moraes, V., Obeica, B., Mora, P., Gonçalves, V. C., Itaborahy, R. M. R., Resende, S. S., Dos Santos Júnior, J. A., Costa, A., Melo, E., Paiva, C. S. M., Silva, M. C., Melo, M. C. L., Martins, M. G., Menezes, M. P. N., Costa, O. L. N., Amorim, M. M. R., E Silva, J. M. M., Moraes, F. R. R., Brum, I. R., Macedo Lins, C. D., Da Luz, M. G. Q., Da Silva, N. C., Silva, R. C. A. F., Leal, E. A. S., Fluminense Federal University, Irmandade da Santa Casa de Misericordia Hospital, Goias Federal University, Sao Paulo Federal University, Universidade Estadual Paulista (UNESP), Harvard Medical School, Clinics Hospital of Parana Federal University, General Hospital of Caxias do Sul University, Carmela Dutra Maternity, Santa Casa Misericordia de Vitoria, Clinics Hospital of Espirito Santo Federal University, Clinics Hospital of Minas Gerais Federal University, Universidade Estadual de Campinas (UNICAMP), Universidade de São Paulo (USP), Maternity School of Dr Mario de Moraes Altenfelder Silva (Vila Nova Cachoeirinha), Guilherme Alvaro Hospital of Lusiada University Center, University Hospital of Jundiai Medical Faculty, Rio de Janeiro Federal University, Regional Hospital of Asa Norte Trophoblastic Disease Center, Julio Muller University Hospital of Mato Grosso Federal University Cuiaba, Regional Hospital of Mato Grosso do Sul. Campo Grande, University Hospital of Piaui Federal University, Pernambuco Institute of Maternal Child Health, Clinics Hospital of Pernambuco Federal University, Lauro Wanderley University Hospital of Paraiba Federal University, University Hospital of Alagoas Federal University, Januario Cicco Maternity School of Rio Grande do Norte University, Marly Sarney State Maternity, University Hospital of Sergipe Federal University, Climerio de Oliveira Maternity of Bahia Federal University, University Hospital of Campina Grande Federal University, Assis Chateaubriand Maternity School of Ceara Federal University, Dona Regina Maternity, Getulio Vargas University Hospital, Roraima General Hospital, Santa Casa de Misericordia do Para Foundation, Mae Luiza Women’s Hospital, Ary Pinheiro Hospital of Base, and Clinics Hospital of Acre

Subjects
Gestational trophoblastic disease, Rare cancers, Hydatidiform mole, Brazil
Abstract

Made available in DSpace on 2022-04-30T09:10:18Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-01-01 OBJECTIVE: To present the Brazilian Network for Gestational Trophoblastic Disease Study Group consensus on management of gestational trophoblastic disease (GTD). STUDY DESIGN: The modified Delphi technique was used in this study to obtain a consensus among Brazilian specialists on the treatment of GTD. For the 64 statements listed, each participant was asked to assign a Likert scale value according to their agreement. The RAND/UCLA method was used to define the level of consensus among the specialists. RESULTS: The response rate of the potential study participants after the 2 rounds was 40/47 (85%). Of the 64 statements presented, there was an agreement on 54/64 (84%). The situations of disagreement were as follows: 1/12 (8%) statements in the section on diagnosis of GTD, 5/10 (50%) statements in the section on treatment of hydatidiform mole (HM), 2/16 (12.5%) statements in the section on diagnosis of gestational trophoblastic neoplasia (GTN), 1/14 (7%) statements in the section on treatment and followup of GTN, and 1/5 (20%) statements in the section on appropriate time to allow pregnancy after HM and GTN. CONCLUSION: This guideline will serve to standardize the conduct among the Brazilian GTD reference centers as well as to guide the new specialized services that may arise and eventually to physicians who may need to treat cases of GTD. Rio de Janeiro Trophoblastic Disease Center Fluminense Federal University Porto Alegre Trophoblastic Disease Center Mario Totta Maternity Ward Irmandade da Santa Casa de Misericordia Hospital Goiania Trophoblastic Disease Center Clinics Hospital of Faculty of Medicine Goias Federal University Sao Paulo Trophoblastic Disease Center Sao Paulo Hospital Paulista School of Medicine Sao Paulo Federal University Botucatu Trophoblastic Disease Center Clinics Hospital of Botucatu Medical School Sao Paulo State University New England Trophoblastic Disease Center Department of Obstetrics and Gynecology Division of Gynecologic Oncology Brigham and Women’s Hospital Dana Farber Cancer Institute/Harvard Cancer Center Harvard Medical School Clinics Hospital of Parana Federal University General Hospital of Caxias do Sul University Carmela Dutra Maternity Santa Casa Misericordia de Vitoria Clinics Hospital of Espirito Santo Federal University Clinics Hospital of Minas Gerais Federal University Campinas University Clinics Hospital of Sao Paulo University Maternity School of Dr Mario de Moraes Altenfelder Silva (Vila Nova Cachoeirinha) Guilherme Alvaro Hospital of Lusiada University Center University Hospital of Jundiai Medical Faculty Rio de Janeiro Federal University Fluminense Federal University Regional Hospital of Asa Norte Trophoblastic Disease Center, Distrito Federal Julio Muller University Hospital of Mato Grosso Federal University Cuiaba Regional Hospital of Mato Grosso do Sul. Campo Grande University Hospital of Piaui Federal University Pernambuco Institute of Maternal Child Health Clinics Hospital of Pernambuco Federal University Lauro Wanderley University Hospital of Paraiba Federal University University Hospital of Alagoas Federal University Januario Cicco Maternity School of Rio Grande do Norte University Marly Sarney State Maternity University Hospital of Sergipe Federal University Climerio de Oliveira Maternity of Bahia Federal University University Hospital of Campina Grande Federal University Assis Chateaubriand Maternity School of Ceara Federal University Dona Regina Maternity Getulio Vargas University Hospital Roraima General Hospital Santa Casa de Misericordia do Para Foundation Mae Luiza Women’s Hospital Ary Pinheiro Hospital of Base Clinics Hospital of Acre Botucatu Trophoblastic Disease Center Clinics Hospital of Botucatu Medical School Sao Paulo State University

2. Centralized coordination of decentralized assistance for patients with gestational trophoblastic disease in Brazil: A viable strategy for developing countries

Author

Braga, A., Burlá, M., Freitas, F., Uberti, E., Viggiano, M., Sue Sun, Maestá, I., Elias, K. M., Berkowitz, R. S., Goldstein, D. P., Grillo, B., Madi, J. M., Costa, F. R. P., Filho, A. C., Filho, H. Z. B., Osanan, G. C., Gomes, D. A. Y., Lin, L. H., Pitorri, A., Silveira, E., Andrade, J., Fernandes, K. G., Rezendefilho, J., Amim Junior, J., Moraes, V., Gonçalves, V. C., Itaborahy, R. M. R., Resende, S. S., Dos Santos Júnior, J. A., Costa, A., Paiva, C. S. M., Silva, M. C., Melo, M. C. L., Martins, M. G., Nogueira Menezes, M. P., Costa, O. L. N., Amorim, M. M. R., E Silva, J. M. M., Deus, J., Lins, C. D. M., Brum, I. R., Da Luz, M. G. Q., Da Silva, N. C., Ferreira Silva, R. C. A., Leal, E. A. S., Fluminense Federal University, Irmandade da Santa Casa de Misericórdia Hospital, Goiás Federal University, São Paulo Federal University, Universidade Estadual Paulista (UNESP), Trophoblastic Tumor Registry, Brigham and Women’s Hospital Dana Farber Cancer Institute/Harvard Cancer Center Harvard Medical School, Clinics Hospital of Paraná Federal University, General Hospital of Caxias do Sul University, Carmela Dutra Maternity, Santa Casa Misericórdia de Vitoria, Clinics Hospital of Espírito Santo Federal University, Clinics Hospital of Minas Gerais Federal University, Universidade Estadual de Campinas (UNICAMP), Universidade de São Paulo (USP), Maternity School of Dr. Mário de Moraes Alten-felder Silva (Vila Nova Cachoeirinha), Guilherme Alvaro Hospital of Lusiada University Center, University Hospital of Jundiai Medical Faculty, Rio de Janeiro Federal University, Regional Hospital of Asa Norte Trophoblastic Disease Center, Júlio Müller University Hospital of Mato Grosso Federal University Cuiabá, Regional Hospital of Mato Grosso do Sul, University Hospital of Piaui Federal University, Instituto de Medicina Integral Professor Fernando Figueira, Lauro Wanderley University Hospital of Paraíba Federal University, University Hospital of Alagoas Federal University, Januário Cicco Maternity School of Rio Grande do Norte University, Maranhão Federal University, University Hospital of Sergipe Federal University, Climério de Oliveira Maternity of Bahia Federal University, University Hospital of Campina Grande Federal University, Assis Chateaubriand Maternity School of Ceará Federal University, Dona Regina Maternity, Roraima General Hospital, Getúlio Vargas University Hospital, Santa Casa de Misericórdia do Pará Foundation, Mãe Luiza Women’s Hospital, Ary Pinheiro Hospital of Base, and Clinics Hospital of Acre

Subjects
Gestational trophoblastic disease, Chemotherapy, Hydatidiform mole, Brazil, Gestational trophoblastic neoplasia, Molar pregnancy
Abstract

Made available in DSpace on 2022-05-02T14:14:49Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-06-01 OBJECTIVE: To report on the Brazilian Association of Gestational Trophoblastic Disease’s (GTD) formation of a network of regional care at specialized centers for women with GTD. STUDY DESIGN: We developed a questionnaire composed of 15 questions, which was sent by email to the 38 Brazilian GTD Reference Center (BGTDRC) Directors who are members of the Brazilian Association of GTD, in order to characterize the professionals involved in the care of patients with GTD and the type of assistance provided. RESULTS: The Directors of the BGTDRCs are usually specialists in Gynecology and Obstetrics (97%), with a median experience of a decade in treating women with GTD. The BGTDRCs are linked to university hospitals in 75% of centers and provide completely free medical care in 87%. However, 52% of centers do not perform chemotherapy in their reference center, and patients are referred elsewhere for chemotherapy. Despite some difficulties, the rate of patients lost to follow-up before human chorionic gonadotropin remission is 9%, and the GTD mortality rate is 0.9%. CONCLUSION: Due to large regional disparities, the BGTDRCs are not uniformly organized. However, under the coordination of the Brazilian Association of GTD there is now strong communication and collaboration among reference centers, which has significantly advanced both patient care and research into the management of these diseases. Rio de Janeiro Trophoblastic Disease Center Maternity School of Rio de Janeiro Federal University and Antonio Pedro University Hospital Fluminense Federal University Porto Alegre Trophoblastic Disease Center Mario Totta Maternity Ward Irmandade da Santa Casa de Misericórdia Hospital Goiania Trophoblastic Disease Center Clinics Hospital of Faculty of Medicine Goiás Federal University São Paulo Trophoblastic Disease Center São Paulo Hospital Paulista School of Medicine São Paulo Federal University Botucatu Trophoblastic Disease Center Clinics Hospital of Botucatu Medical School São Paulo State University New England Trophoblastic Disease Center Trophoblastic Tumor Registry Division of Gynecologic Oncology Department of Obstetrics and Gynecology Brigham and Women’s Hospital Dana Farber Cancer Institute/Harvard Cancer Center Harvard Medical School Clinics Hospital of Paraná Federal University General Hospital of Caxias do Sul University Carmela Dutra Maternity Santa Casa Misericórdia de Vitoria Clinics Hospital of Espírito Santo Federal University Clinics Hospital of Minas Gerais Federal University Campinas University Clinics Hospital of São Paulo University Maternity School of Dr. Mário de Moraes Alten-felder Silva (Vila Nova Cachoeirinha) Guilherme Alvaro Hospital of Lusiada University Center University Hospital of Jundiai Medical Faculty Rio de Janeiro Federal University Fluminense Federal University Regional Hospital of Asa Norte Trophoblastic Disease Center, Distrito Federal Júlio Müller University Hospital of Mato Grosso Federal University Cuiabá Regional Hospital of Mato Grosso do Sul University Hospital of Piaui Federal University Instituto de Medicina Integral Professor Fernando Figueira Lauro Wanderley University Hospital of Paraíba Federal University University Hospital of Alagoas Federal University Januário Cicco Maternity School of Rio Grande do Norte University Maternal Child Unity of University Hospital Maranhão Federal University University Hospital of Sergipe Federal University Climério de Oliveira Maternity of Bahia Federal University University Hospital of Campina Grande Federal University Assis Chateaubriand Maternity School of Ceará Federal University Dona Regina Maternity Roraima General Hospital Getúlio Vargas University Hospital Santa Casa de Misericórdia do Pará Foundation Mãe Luiza Women’s Hospital Ary Pinheiro Hospital of Base Clinics Hospital of Acre Botucatu Trophoblastic Disease Center Clinics Hospital of Botucatu Medical School São Paulo State University

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