Table 3: Treatment protocols for stage I gestational trophoblastic neoplasia (New England Trophoblastic Disease Center).

InitialSequential MTX/ACT-D
Hysterectomy (with adjunctive single-agent chemotherapy)

Resistant to both single-agentsMAC
EMACO, if MAC fails
Hysterectomy (with adjunctive multiagent chemotherapy)
Local uterine resection (for localized lesion, to preserve, fertility)

Followup12 consecutive months of normal hCG levels
Contraception mandatory

ACT-D: actinomycin D; EMACO: etoposide, methotrexate, actinomycin D, cytoxan, oncovin; MAC: methotrexate, actinomycin D, cytoxan; MTX: methotrexate.