A patient develops GTN after a complete hydatidiform mole. She has a uterine lesion, βhCG of 12,000 mIU/mL, no metastases on imaging, and duration of disease less than 4 months. Her WHO/FIGO prognostic score is calculated and found to be 3. The appropriate treatment is:
- A Single-agent chemotherapy (methotrexate or actinomycin-D) ✓
- B EMA-CO chemotherapy regimen
- C Hysterectomy followed by single-agent chemotherapy
- D Multi-agent chemotherapy with EMA-EP
Correct answer: A. Single-agent chemotherapy (methotrexate or actinomycin-D)
Explanation
A WHO/FIGO prognostic score ≤6 classifies GTN as low-risk, for which single-agent chemotherapy (methotrexate or actinomycin-D) achieves cure rates exceeding 90%. EMA-CO is reserved for high-risk GTN (score ≥7). EMA-EP is used for resistant or relapsed high-risk disease. Hysterectomy may be an option for localized disease in women who have completed childbearing but is not routine.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.