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. 1994 Mar;39(3):217-22.

High-risk Metastatic Gestational Trophoblastic Tumors. Current Management

  • PMID: 7518518

High-risk Metastatic Gestational Trophoblastic Tumors. Current Management

J R Lurain. J Reprod Med. .


Aggressive multimodality therapy with an appropriate combination of chemotherapy and adjuvant radiotherapy and surgery has resulted in a cure for most patients with high-risk, metastatic gestational trophoblastic tumors. The EMA-CO chemotherapy regimen, employing etoposide, high-dose methotrexate, actinomycin D, cyclophosphamide and vincristine, is highly effective and well tolerated. Complete response rates of 80-94% and survival rates of 82-100% have been reported. For patients with central nervous system metastases, whole brain irradiation is given simultaneously with the initiation of combination chemotherapy employing a high-dose methotrexate infusion. Surgical procedures, especially hysterectomy and thoracotomy, may be useful for the purpose of removing known foci of chemotherapy-resistant disease. Subsequent salvage chemotherapy with cisplatin and bleomycin in combination with etoposide will result in a cure for almost all patients. The factors that are most important in determining response to treatment in patients with metastatic, high-risk disease are metastases to sites other than the lung and vagina, more than eight metastases, previous failed chemotherapy and a World Health Organization score > or = 8.

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