Table 5: Treatment protocol for stage IV gestational trophoblastic neoplasia (New England Trophoblastic Disease Center).

InitialEMACO
With brain metastases:
Radiation
Craniotomy for peripheral lesions
With liver metastases:
Embolization
Resection to manage complications

ResistantSalvage chemotherapy:
EMAEP
VBP
Experimental protocols
Surgery, as indicated
Hepatic artery infusion or embolization, as indicated

FollowupWeekly 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.