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

Low risk
 Initial therapySequential MTX/ACT-D
 Resistant therapyMAC or EMA/CO
Surgery, as indicated

High risk
 Initial therapyEMACO
 Resistant therapyEMAEP
Surgery, as indicated

Followup12 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.