Tx for GTN

Question 1

Figo score

Answer 1

• Low risk
• Single-agent intramuscular methotrexate alternating daily with folinic acid for 1 week followed by 6 rest days.
• Continue tx until hCG back to normal and for further 6/52 after that
• 100% cure rate

Question 2

Figo score > 7

Answer 2

• High risk
• intravenous multi-agent chemotherapy, which includes combinations of methotrexate, dactinomycin, etoposide, cyclophosphamide and vincristine
• Continue tx until hCG back to normal and for further 6/52 that
• 95 % cure rate

Question 3

Chemotherapy facts for GTN

Answer 3

• Women who receive chemotherapy for GTN are likely to have an earlier menopause.
• Women with high-risk GTN who require multi-agent chemotherapy which includes etoposide should be
  advised that they may be at increased risk of developing secondary cancers

Question 4

Contraception after GTD

Answer 4

• Barrier methods of contraception until hCG levels revert to normal.
• Once hCG normalised,COC may be used. There is no evidence as to whether single-agent progestogens have any effect on GTN.
• If OC has been started before the diagnosis of GTD was made, the woman can continue OC but she should be advised that there is a potential but low increased
  risk of developing GTN.
• Intrauterine contraceptive devices should not be used until hCG levels are normal to reduce the risk of
  uterine perforation