Current Chemotherapeutic Management of Patients with Gestational Trophoblastic Neoplasia

Table 5

Treatment protocol for stage IV gestational trophoblastic neoplasia (New England Trophoblastic Disease Center).

Initial	EMACO
	With brain metastases:
	Radiation
	Craniotomy for peripheral lesions
	With liver metastases:
	Embolization
	Resection to manage complications
Resistant	Salvage chemotherapy:
	EMAEP
	VBP
	Experimental protocols
	Surgery, as indicated
	Hepatic artery infusion or embolization, as indicated
Followup	Weekly hCG levels until undetectable for 3 weeks, then monthly for 24 months
	Contraception for 24 months

EMACO: etoposide, methotrexate, actinomycin D, cytoxan, oncovin; EMAEP: etoposide. methotrexate, actinomycin D, carboplatin; VBP: vinblastine, bleomycin, carboplatin.