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.