A 34-year-old is diagnosed with gestational choriocarcinoma post-molar evacuation. Her WHO prognostic scoring gives a total score of 11 (high-risk). According to FIGO/WHO guidelines, which is the appropriate first-line treatment?
- A Single-agent methotrexate with folinic acid rescue
- B EMA-CO regimen (etoposide, methotrexate, actinomycin-D, cyclophosphamide, vincristine) ✓
- C EP-EMA regimen as first-line due to score >7
- D Hysterectomy followed by adjuvant chemotherapy
Correct answer: B. EMA-CO regimen (etoposide, methotrexate, actinomycin-D, cyclophosphamide, vincristine)
Explanation
WHO prognostic score ≥7 defines high-risk gestational trophoblastic neoplasia. Standard first-line treatment for high-risk GTN is the EMA-CO regimen (etoposide, methotrexate, actinomycin-D alternating with cyclophosphamide and vincristine), with cure rates >85% even in metastatic disease. Single-agent methotrexate or actinomycin-D is used only for low-risk GTN (score <7). EP-EMA is reserved for EMA-CO-resistant or very high-risk disease (brain metastases, WHO score >12). Surgery is adjuvant only in selected resistance cases.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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