A 27-year-old woman has a complete hydatidiform mole evacuated. Post-evacuation beta-hCG plateau at week 4 (less than 10% decline over 3 consecutive weekly values). According to FIGO 2021 criteria for gestational trophoblastic neoplasia (GTN), what is the scoring system used to determine treatment intensity?
- A FIGO anatomic staging alone (Stage I-IV) determines chemotherapy regimen
- B Hammond classification with three tiers: good, poor, and ultra-high risk
- C Modified WHO/FIGO prognostic scoring system (score ≤6 = low-risk, single-agent MTX; score ≥7 = high-risk, multi-agent EMA-CO) ✓
- D NCI classification based on hCG level alone: <40,000 mIU/mL = single agent
Explanation
FIGO/WHO scoring system for GTN assigns points (0, 1, 2, 4) based on: age, antecedent pregnancy type, interval from index pregnancy, pre-treatment hCG, largest tumor size, site of metastases, number of metastases, previous failed chemotherapy. Score ≤6 = low risk → single-agent MTX or actinomycin-D with >95% cure rate; Score ≥7 = high risk → multi-agent EMA-CO (etoposide, MTX, actinomycin-D, cyclophosphamide, vincristine) with ~85-90% cure rate. This combined FIGO staging + WHO risk score guides treatment globally and is used in India. Ultra-high risk (score ≥13) may require induction with EP before EMA-CO.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.