Table 5.
Treatment protocol for stage IV gestational trophoblastic neoplasia (New England Trophoblastic Disease Center).
| Initial | EMACO |
| With brain metastases: | |
| Radiation | |
| Craniotomy for peripheral lesions | |
| With liver metastases: | |
| Embolization | |
| Resection to manage complications | |
|
| |
| Resistant | Salvage chemotherapy: |
| EMAEP | |
| VBP | |
| Experimental protocols | |
| Surgery, as indicated | |
| Hepatic artery infusion or embolization, as indicated | |
|
| |
| Followup | Weekly hCG levels until undetectable for 3 weeks, then monthly for 24 months |
| Contraception for 24 months | |
EMACO: etoposide, methotrexate, actinomycin D, cytoxan, oncovin; EMAEP: etoposide. methotrexate, actinomycin D, carboplatin; VBP: vinblastine, bleomycin, carboplatin.