Question

Patient with post molar evacuation, now has lesion in lungs cannon ball appearance . Which is the best management?

• A. Hysterectomy
• B. Emaco regimen
• C. Inj. methotrexate
• D. Multiple dose of Inj. methotrexate

Answer 1

The Correct Option is B

In a clinical scenario where a patient has undergone a molar evacuation and subsequently develops lung lesions with a cannonball appearance, the concern is the metastasis of gestational trophoblastic neoplasia (GTN). This pattern is characteristic of metastatic GTN. The appropriate management involves chemotherapy, particularly when there is high-risk metastatic GTN.

The standard treatment for high-risk GTN is the 'EMA-CO' regimen, which stands for:

1. Etodimate (E)
2. Methotrexate with folinic acid rescue (M)
3. Actinomycin-D (A)
4. Cyclosphophamide (C)
5. Vincristine (Oncovin, O)

This multi-agent chemotherapy regimen is necessary to effectively manage and treat high-risk GTN that presents with significant metastatic disease like pulmonary metastases.

Considering the options provided:

Option	Rationale
Hysterectomy	Generally considered for localized disease or heavy uterine bleeding, not primarily for metastatic disease.
Emaco regimen	Appropriate choice for high-risk GTN with metastatic spread, like lung lesions of cannonball appearance.
Inj. methotrexate	Typically used for low-risk GTN.
Multiple dose of Inj. methotrexate	Still less effective than EMA-CO for high-risk metastatic disease.

Thus, the best management strategy for this patient is the 'Emaco regimen'.