A 32-year-old woman with complete hydatidiform mole undergoes suction evacuation. Two months later, beta-hCG is 2,800 IU/L. Chest X-ray shows three pulmonary nodules, the largest measuring 1.8 cm. Pelvic ultrasound shows a 2 cm enhancing uterine lesion. Her FIGO/WHO prognostic score is calculated and found to be 7. The most appropriate first-line chemotherapy is:
- A EMA-CO (etoposide, methotrexate, actinomycin-D, cyclophosphamide, vincristine) ✓
- B Single-agent methotrexate with leucovorin rescue
- C Single-agent actinomycin-D
- D BEP (bleomycin, etoposide, cisplatin)
Correct answer: A. EMA-CO (etoposide, methotrexate, actinomycin-D, cyclophosphamide, vincristine)
Explanation
A FIGO/WHO prognostic score of 7 falls in the high-risk category (score ≥7), where EMA-CO is the standard first-line multi-agent regimen achieving cure rates of approximately 85–90%. Single-agent chemotherapy (methotrexate or actinomycin-D) is reserved for low-risk GTN (score 0–6). BEP is used for malignant germ cell tumours, not GTN. The three pulmonary metastases and uterine lesion contribute to the high-risk score.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.