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John I. Brewer Trophoblastic Disease Center

The John I. Brewer Trophoblastic Disease Center of Northwestern University's Feinberg School of Medicine was established within the Department of Obstetrics and Gynecology in 1962. The center's focus is to study and treat gestational trophoblastic diseases. These include rare growth disturbances of the placenta such as hydatidiform mole, invasive mole, choriocarcinoma, and placental site trophoblastic tumor. The center serves as a treatment facility for patients with trophoblastic diseases, a consultation service for physicians and patients, and a clinical and laboratory research unit. More than 6,000 patients have been referred to the Brewer Center from 42 states and 7 foreign countries, including approximately 800 who have received treatment for trophoblastic tumors at the center.

Chemotherapy is the main form of therapy, usually including methotrexate or actinomycin D for patients with the best prognosis, or a combination of those agents with etoposide, cyclophosphamide, and oncovin (EMA-CO) for patients with the most extensive disease. Irradiation is given to patients with brain metastasis. Adjuvant surgical procedures, especially hysterectomy and thoracotomy, are used in selected patients for removing foci in chemotherapy-resistant disease. The overall cure rate now exceeds 95 percent: 100 percent for patients without evidence of metastasis and  over 90 percent for patients with metastatic disease.

The successful treatment of gestational trophoblastic diseases with chemotherapy has resulted in an increasing number of women who have retained reproductive potential. A large number of successful pregnancies has occurred in this group of patients. In general, they experience no increase in abortions, stillbirths, congenital anomalies, prematurity, or major obstetrical complications. No evidence exists of reactivation of disease due to a subsequent pregnancy; however, patients have approximately a one percent risk of another trophoblastic disease episode in a subsequent pregnancy. Therefore, patients who do become pregnant again should have an ultrasound early in pregnancy to document a normal pregnancy, the products of conception or placenta should be examined pathologically, and a serum quantitative hCG (pregnancy test) should be obtained about six weeks after pregnancy termination.
Research conducted at the center has resulted in publication of more than 100 articles in scientific journals and books. Significant contributions have been made in several areas, including:

Gestational trophoblastic tumors are rare and require a multimodality approach for successful treatment. With current therapies, trophoblastic tumors are now nearly universally curable. Almost all patients treated primarily at the Brewer Trophoblastic Disease Center since 1981 have been cured.

For additional information, please call (312) 472-4684.

This page last updated on­ Mon Apr 28, 2008 2:32 PM