••• Chapter 50^ Gestational Trophoblastic Disease^499
❍ Although most forms of metastatic cancers yield poor survival rates, malignant GTD is considered a curable
form of cancer. Describe the life table survival rates for patients with nonmetastatic, metastatic good-
prognosis, and metastatic poor-prognosis as defined by the clinical classification system.
Approximately 100% of patients in the first two categories are cured of disease. However, this rate drops of to
approximately 80% in the metastatic poor-prognosis group.
❍ What is considered to be the highest risk factor in the metastatic poor-prognosis group in the clinical
classification system?
Failed prior chemotherapy is the most significant factor. Salvage rates of 14% and 70% have been reported for
patients with poor-prognosis metastatic disease treated initially with single-agent and multiagent chemotherapy,
respectively.
❍ High-risk/poor-prognosis metastatic GTD is generally treated with a multiagent chemotherapy regimen
called EMA-CO. What are the five drugs involved in this regimen?
Etoposide, methotrexate, dactinomycin, cyclophosphamide, and vincristine are the five chemotherapeutic agents
that make up the EMA-CO regimen.
❍ What percentage of remission rate is generally obtainable with the EMA-CO regimen in high-risk/
poor-prognosis metastatic patients with GTD?
Approximately 80% of patients will have their disease put into remission by this treatment regimen.
❍ How long should a woman with nonmetastatic GTD or low-risk metastatic GTD undergo chemotherapy?
Treatment should continue 1 to 2 cycles after obtaining the first normal hCG value.
❍ How long should treatment continue for a patient with high-risk metastatic GTD?
Chemotherapy should be continued for at least 3 additional courses after the hCG levels have normalized.
❍ Are women with a complete molar pregnancy at increased risk of a molar pregnancy in future pregnancies?
Yes. But only 1 in 100 women have at least two molar pregnancies. Even women with two molar pregnancies may
still achieve a normal full term pregnancy.
❍ What are the recommendations for women with a prior molar pregnancy when a subsequent pregnancy
occurs?
Obtain a pelvic ultrasound during the first trimester to confirm a normal gestation. Obtain a hCG measurement
6 weeks postpartum to exclude occult trophoblastic neoplasia.