Pulmonary metastases increase chemotherapy resistance and recurrence of gestational trophoblastic neoplasia.

Abstract

The commonest groups of patients with gestational trophoblastic neoplasia (GTN) are those with persistently raised serum hCG following evacuation of uterus and choriocarcinoma. Patients with low risk disease are treated with single agent chemotherapy using methotrexate and folinic acid rescue whereas those with high risk disease are treated with a multi-agent regime with etoposide, methotrexate, actinomycin-D, cyclophosphomide, vincristine (EMA-CO). Methotrexate chemotherapy is usually well tolerated and associated with less toxic adverse effects.