Table 4: Treatment protocol for stages II and III gestational trophoblastic neoplasia (New England Trophoblastic Disease center).

Low risk  Initial therapy Sequential MTX/ACT-D  Resistant therapy MAC or EMA/CO Surgery, as indicated High risk  Initial therapy EMACO  Resistant therapy EMAEP VBP Surgery, as indicated Followup 12 consecutive months of undetectable hCG levels Contraception for 12 months

ACT-D: actinomycin D; EMACO: etoposide, methotrexate, actinomycin D, cytoxan, oncovin; EMAEP: etoposide, methotrexate, actinomycin D, carboplatin; MAC: methotrexate, actinomycin D, cytoxan; MTX: methotrexate; VBP: vinblastine, bleomyCin, carboplatin.