A 32-year-old woman with GTN has the following WHO score: antecedent mole (0), interval >12 months (4), β-hCG >100,000 IU/L (4), largest tumour 5 cm (2), lung metastases (0), no prior chemotherapy (0). What is her total score and what is the recommended first-line treatment?
- A Score 10; single-agent methotrexate
- B Score 6; single-agent actinomycin D
- C Score 10; multi-agent chemotherapy (EMA-CO) ✓
- D Score 8; multi-agent EMA-EP regimen
Correct answer: C. Score 10; multi-agent chemotherapy (EMA-CO)
Explanation
WHO GTN scoring: antecedent mole = 0; interval >12 months = 4; β-hCG >100,000 IU/L = 4; tumour size ≥5 cm = 2; lung metastases = 0; no prior chemo = 0. Total = 0+4+4+2+0+0 = 10. Score ≥7 is high risk and requires multi-agent chemotherapy. EMA-CO (etoposide, methotrexate, actinomycin D / cyclophosphamide, vincristine) is the standard first-line regimen for high-risk GTN with cure rates >85%. Single-agent methotrexate is reserved for low-risk disease (score ≤6).
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.