HIGH-RISK METASTATIC GESTATIONAL TROPHOBLASTIC TUMORS - CURRENT MANAGEMENT

Aggressive multimodality therapy with an appropriate combination of ch emotherapy and adjuvant radiotherapy and surgery has resulted in a cur e for most patients with high-risk, metastatic gestational trophoblast ic 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 si multaneously with the initiation of combination chemotherapy employing a high-dose methotrexate infusion. Surgical procedures, especially hy sterectomy and thoracotomy, may be useful for the purpose of removing known foci of chemotherapy-resistant disease. Subsequent salvage chemo therapy with cisplatin and bleomycin in combination with etoposide wil l result in a cure for almost all patients. The factors that are most important in determining response to treatment in patients with metast atic, high-risk disease are metastases to sites other than the lung an d vagina, mor e than eight metastases, previous failed chemotherapy an d a World Health Organization score greater than or equal to 8.