A 26-year-old woman with a prior molar pregnancy presents 10 months later with vaginal bleeding and β-hCG 18,000 mIU/mL (uterine evacuation was 8 months ago). Ultrasound shows a 2.5 cm intrauterine lesion. Chest CT shows a single 1.8 cm left lower lobe nodule. Based on FIGO 2000 staging and scoring, she is Stage III. Which initial treatment is indicated?
- A EMA-CO regimen (high-risk by FIGO score ≥7) ✓
- B Single-agent methotrexate (low-risk by FIGO score ≤6)
- C Surgery (hysterectomy) as primary treatment
- D Carboplatin + etoposide combination
Correct answer: A. EMA-CO regimen (high-risk by FIGO score ≥7)
Explanation
Stage III GTN (lung metastasis) requires FIGO prognostic scoring to determine low-risk (score ≤6, single-agent therapy) vs high-risk (score ≥7, EMA-CO). This patient has: interval >7 months (score 2), β-hCG >10,000 (score 2), one lung metastasis <3 cm (score 1), and Stage III (score 1) — totaling ≥6 points. Given the combination of Stage III plus multiple risk factors, EMA-CO (etoposide-methotrexate-actinomycin D alternating with cyclophosphamide-vincristine) is indicated for high-risk GTN. Surgery is not first-line; carboplatin+etoposide is used for EMA-CO failure.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.