High-risk GTN — SCE Medical Oncology MCQ

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ModerateGynaecological CancersHigh-risk GTNSCE Medical Oncology

A 42-year-old woman with gestational trophoblastic neoplasia (GTN) has a FIGO prognostic score of 8 (high-risk). What chemotherapy regimen is standard for high-risk GTN?

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Correct answer: E — EMA-CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine)

High-risk GTN (FIGO score ≥7) is treated with EMA-CO multi-agent chemotherapy, achieving cure rates of approximately 85-95%. For ultra-high-risk (score ≥12 or WHO brain/liver metastases), modified EMA-CO or EP-EMA (etoposide-cisplatin alternating with etoposide-methotrexate-actinomycin D) may be used. Serial HCG monitoring guides treatment duration — chemotherapy continues until HCG normalisation plus 6-8 consolidation weeks. UK management is centralised at Charing Cross and Sheffield GTD centres.

Reference: ESMO 2024 GTD; NICE NG; FIGO GTN scoring system; Seckl et al Lancet 2010