5024 Background: Patients with Gestational Trophoblastic Neoplasia (GTN) classified as high risk, or who fail low risk single agent chemotherapy usually receive etoposide, methotrexate and actinomycin D alternating weekly with cyclophosphamide and vincristine (EMA/CO). At our institute overall survival (OS) after EMA/CO was 87% between 1979-1995. Here we compare a more recent patient cohort (1994-2010) to determine whether survival rates have improved. Methods: The Charing Cross GTD database was screened for patients who received EMA/CO chemotherapy between Jan 1994 and 2010. Patient characteristics and outcomes were recorded. Pathology was centrally reviewed and patients with PSTT or non-gestational tumours were excluded. The introduction in 1994 and use of low-dose etoposide 100mg/m2 and cisplatin 20mg/m2 (EP) on days 1 and 2 repeated weekly as induction chemotherapy for 1-2 weeks before commencing EMA/CO was noted. Results: EMA/CO was given to 442 patients. This was first line therapy for 170 with high risk disease, and second line for 278 failing single agent chemotherapy. OS (median follow-up 4.29 years) was 98% (9 deaths / 442 pts; 95% CI : 96.6-99.3%)in the modern, compared to 87% (95% CI : 81.9 - 90.5%) in our previous cohort. This was not explained by an increase in low-risk patients receiving EMA/CO. EP-induction chemotherapy was given to 21% (35/170) of high risk patients who were significantly more likely to have a high disease burden (FIGO score >8 and > 6 metastases (p<0.01)). Strikingly, this correlated with a reduction in early deaths from 4% (95% CI : 1.9-6.9) in the early pre-EP cohort to 0.2% (95% CI : 0-0.65%) in the current cohort. Of the remaining 8 patients, 7 died due to drug resistance, and one of pulmonary embolism post surgery. Conclusions: Overall survival following EMA/CO for GTN has improved significantly from 87% to 98% in our recent patient cohort. This is partly due to the introduction of low-dose EP-induction chemotherapy for patients with advanced disease. Low dose EP induction chemotherapy should be routinely considered for patients with a FIGO score >8 and metastasis score >6 to minimise the risk of early deaths.