A 27-year-old woman is diagnosed with gestational trophoblastic neoplasia (GTN) after molar evacuation. Beta-hCG plateau at 500 IU/L for 3 consecutive weekly measurements at 10 weeks post-evacuation. She is WHO scoring 4, FIGO Stage I. What is the APPROPRIATE management?
- A Multi-agent chemotherapy with EMA-CO regimen
- B Hysterectomy followed by surveillance hCG
- C Single-agent chemotherapy with methotrexate or actinomycin-D ✓
- D Repeat suction evacuation followed by surveillance
Correct answer: C. Single-agent chemotherapy with methotrexate or actinomycin-D
Explanation
FIGO Stage I GTN (confined to uterus) with WHO prognostic score ≤6 is classified as low-risk GTN. Single-agent chemotherapy with either methotrexate (MTX with folinic acid rescue) or actinomycin-D is the standard treatment, with >95% cure rate. Multi-agent EMA-CO is reserved for high-risk GTN (WHO score ≥7 or Stage III–IV). Repeat evacuation is not recommended after GTN diagnosis as it does not reduce hCG and increases uterine perforation risk. Hysterectomy may be an option for older women not desiring fertility but is not first-line.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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