A 28-year-old woman is diagnosed with gestational trophoblastic neoplasia (GTN) post-molar pregnancy. She has beta-hCG of 12,000 mIU/mL at 6 weeks post-evacuation with a plateau (less than 10% rise or fall) over 3 weeks. FIGO anatomic staging shows disease confined to the uterus (Stage I). WHO scoring gives her a total of 3. What is the most appropriate first-line treatment?
- A EMA-CO (etoposide, methotrexate, actinomycin-D + cyclophosphamide, vincristine)
- B Hysterectomy as definitive treatment
- C Single-agent methotrexate (low-risk GTN protocol) ✓
- D Combined bleomycin, etoposide, and cisplatin (BEP)
Explanation
GTN is classified by FIGO combined staging and WHO prognostic scoring into low-risk (score 0–6) and high-risk (score ≥7). This patient has FIGO Stage I with WHO score 3, placing her in the low-risk category. Low-risk GTN is treated with single-agent chemotherapy—either methotrexate (various protocols: intramuscular, IV bolus, or alternating with folinic acid) or actinomycin-D. Cure rates for low-risk GTN with single-agent therapy approach 85–90%. EMA-CO is the standard regimen for high-risk GTN. Hysterectomy may be considered for low-risk GTN in women who have completed childbearing but is not first-line as GTN is highly chemosensitive. BEP is used for germ cell tumors, not GTN.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.