A 25-year-old develops choriocarcinoma 4 months after a term delivery. Pre-treatment β-hCG is 90,000 IU/L, the largest tumour is >5 cm, and there are 4 lung metastases; she has had no prior chemotherapy. Using the FIGO/WHO prognostic scoring system, how is she classified and managed?

• A Low risk (score ≤6); single-agent methotrexate indicated
• B High risk (score ≥7); multi-agent chemotherapy (EMA-CO) indicated ✓
• C Intermediate risk; requires radiotherapy combined with chemotherapy
• D Ultra-high risk; bone marrow transplant required

Explanation

FIGO/WHO prognostic score: age <40 = 0; antecedent term pregnancy = 2; interval from index pregnancy 4–6 months = 1; pre-treatment β-hCG 10,000–100,000 IU/L (here 90,000) = 2; largest tumour >5 cm = 2; lung metastases = 0; 1–4 metastases = 1; no prior chemotherapy = 0. Total = 8, which is ≥7, so she is high-risk. High-risk GTN requires multi-agent chemotherapy — EMA-CO (etoposide, methotrexate, actinomycin-D, cyclophosphamide, vincristine) is the standard regimen, with cure rates exceeding 90%.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.