A woman is diagnosed with gestational trophoblastic neoplasia (GTN) following complete mole evacuation. beta-hCG is 28,000 mIU/mL at 8 weeks post-evacuation. The GTN score (WHO prognostic scoring system modified by FIGO 2000) is calculated at 6. What treatment is appropriate?
- A High-risk GTN: EMA-CO combination chemotherapy
- B Ultra-high-risk GTN: EP induction followed by EMA-CO
- C Surgical resection (hysterectomy) without chemotherapy
- D Low-risk GTN: single-agent methotrexate or actinomycin-D chemotherapy ✓
Explanation
The WHO/FIGO prognostic scoring system for GTN classifies patients as low-risk (score 0–6) or high-risk (score ≥7). A score of 6 places this patient in the low-risk category, for which single-agent chemotherapy — methotrexate (with folinic acid rescue in multi-day regimens) or actinomycin-D — achieves cure rates of >95%. High-risk GTN (score ≥7) requires combination EMA-CO (etoposide, methotrexate, actinomycin-D, cyclophosphamide, vincristine). Ultra-high-risk disease (score >12 or liver/brain metastases) receives EP induction first. Hysterectomy is not routinely indicated except as an adjunct in resistant localised disease.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.