The John I. Brewer Trophoblastic Disease Center of Northwestern University's Feinberg School of Medicine (Brewer Center) was established within the Department of Obstetrics and Gynecology in 1962. The center studies and treats 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 seven foreign countries, including approximately 850 who have received treatment for trophoblastic tumors at the center.
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:
- The origin of choriocarcinoma within the placenta
- Management of hydatidiform moles
- Treatment of non-, low-risk, and high-risk metastatic disease
- Identification of factors contributing to adverse outcomes
- Treatment of resistant disease
- Role of surgery in the management of trophoblastic diseases
- The effect of contraception on the development of gestational trophoblastic disease
- Causes of repeat gestational trophoblastic disease
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 1980 have been cured.
The Brewer Center will host the XVII World Congress on Gestational Trophoblastic Diseases in 2013.
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 vincristine 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.
Contact the John I. Brewer Trophoblastic Disease Center at 312-472-4684.