Question

What are the indications and protocols of chemotherapy in this case?

Hint:

The key to effective chemotherapy in GTN is close monitoring of hCG levels to guide treatment decisions and adjust protocols as necessary.

Answer 1

Step 1: Indications for Chemotherapy in GTN.
Chemotherapy is the primary treatment for gestational trophoblastic neoplasia (GTN), especially in cases of choriocarcinoma and invasive mole. The following factors indicate the need for chemotherapy:
(1) High-risk GTN: This includes patients with high hCG levels, evidence of metastatic disease, or large uterine masses.
(2) Invasive Mole or Choriocarcinoma: Chemotherapy is indicated when the disease is invasive or metastasized beyond the uterus (common sites include the lungs, liver, and brain).
(3) Failure of Surgery or Persistence of Disease: If the tumor does not resolve after uterine evacuation or if symptoms persist with elevated hCG levels, chemotherapy is indicated.
Step 2: Chemotherapy Protocols.
The standard chemotherapy regimen for GTN is EMA-CO, which includes:
(1) Etoposide (50 mg/m² IV on days 1 and 2)
(2) Methotrexate (0.4 mg/kg IV on days 1, 3, and 5)
(3) Actinomycin D (0.5 mg/m² IV on day 1)
(4) Cyclophosphamide (500 mg/m² IV on day 2)
For high-risk cases, a more aggressive protocol, such as EMA-EP (adding etoposide and cisplatin), may be used.
Step 3: Monitoring During Chemotherapy.
- hCG levels are measured regularly (every 1-2 weeks) to assess the response to treatment. A drop in hCG indicates effective treatment.
- Supportive care: Anti-nausea medications, hydration, and blood count monitoring are essential during chemotherapy to manage side effects.
Step 4: Post-Treatment Follow-up.
After successful treatment, patients should continue to be monitored for several months (up to 1 year) to ensure the disease does not recur. Any rise in hCG levels warrants re-evaluation and possible further treatment.