Six months after evacuation of a complete mole, a 24-year-old woman has a plateaued serum beta-hCG. Chest radiograph shows a single 2 cm lung nodule, and pelvic examination reveals a 3 cm vaginal nodule. Her FIGO/WHO prognostic score totals 4. The most appropriate first-line treatment is:

• A Total hysterectomy with bilateral salpingo-oophorectomy
• B Multiagent chemotherapy with EMA-CO
• C Single-agent chemotherapy with methotrexate or actinomycin D ✓
• D Pulmonary metastasectomy followed by chemotherapy

Explanation

C FIGO score of 4 places this patient in the low-risk category (score 0 to 6), for which single-agent therapy achieves cure rates above 90 percent. Metastatic disease and even histological choriocarcinoma do not mandate multiagent regimens when the score is low; escalation to EMA-CO occurs for scores of 7 or above or resistance to single agents. Surgery alone is inadequate for metastatic gestational trophoblastic neoplasia.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.