In gestational trophoblastic neoplasia (GTN), the WHO prognostic scoring system is used to guide treatment. A patient has a score of 5 based on: age >40, serum β-hCG 40,000 IU/L at 6 months after antecedent pregnancy, liver metastasis, and prior chemotherapy. The correct classification and initial treatment is:

• A Low-risk GTN (score 0–6); single-agent methotrexate
• B Low-risk GTN (score 0–6); single-agent actinomycin-D
• C High-risk GTN (score ≥7); platinum-based BEP chemotherapy
• D High-risk GTN (score ≥7); multi-agent EMA-CO chemotherapy ✓

Explanation

The FIGO/WHO prognostic scoring system classifies GTN as low-risk (0–6, single-agent methotrexate or actinomycin-D) or high-risk (≥7, multi-agent chemotherapy). This patient carries several high-scoring features — liver metastasis (scores 4), a long interval from the index pregnancy, β-hCG in the 10,000–100,000 range, and prior chemotherapy — summing well above 7, so she is high-risk. The standard high-risk regimen is EMA-CO (etoposide, methotrexate, actinomycin-D, cyclophosphamide, vincristine), achieving ~85% remission; BEP is a germ-cell-tumour regimen and is not used in GTN.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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