Explore the vast range of titles available.

Background Non‐gestational choriocarcinoma (NGCC) is a rare type of malignant tumor. Primary lesions are typically detected in the ovary and rarely invade the corpus uteri and cervix. NGCC usually has a poor prognosis due to the difficulty in achieving early and accurate diagnoses because of its rarity. Case This case described a female who was initially diagnosed with gestational choriocarcinoma and treated with EMA‐CO chemotherapy. However, subsequent short tandem repeat (STR) analysis confirmed the diagnosis as NGCC, prompting surgical intervention. Given her favorable response and after thorough communication, three additional cycles of EMA‐CO chemotherapy were recommended. At her last follow‐up, her human chorionic gonadotropin level had normalized. Conclusion This case presents a rare instance of NGCC with simultaneous uterine and cervical involvement, confirmed by STR analysis and successfully managed with the EMA‐CO regime. It highlights the necessity of precise diagnosis and personalized treatment for effective management of this disease.

Background: Pregnancy after treatment for high‑risk gestational trophoblastic neoplasia (GTN) is generally considered feasible with appropriate timing and surveillance. Data are limited for patients who experienced significant chemotherapy hypersensitivity and who declined consolidation chemotherapy. Case Presentation: A 27‑year‑old with two previous normal vaginal deliveries with prior pre‑eclampsia (2020) and postpartum haemorrhage from uterine atony (2022), was diagnosed in 2023 with FIGO stage III: 9 choriocarcinoma with right‑lung metastasis. Brain MRI showed no intracranial disease. She commenced EMA‑CO chemotherapy. Intravenous etoposide caused Grade 2–3 infusion reactions requiring interruption, premedication, slower re‑challenge, and eventual transition to oral etoposide. She declined consolidation chemotherapy and entered surveillance. Approximately one year later, she conceived and had uncomplicated antenatal care. At 37 + 1 weeks, she had a spontaneous vaginal delivery of a healthy female infant. Postpartum issues included intermittent uterine atony responsive to uterotonics, hypokalaemia to 2.5 mmol/L requiring intravenous replacement, and pre‑eclampsia (urine protein–creatinine ratio 0.3 g/g) without severe features. Upon discharge plans for early obstetric oncology follow‑up and immediate β‑hCG reassessment were made. Conclusions: A favourable term pregnancy outcome can occur after high‑risk metastatic GTN treated with EMA‑CO despite clinically significant etoposide hypersensitivity and without consolidation therapy. Vigilant surveillance coordinated peripartum care, and early postpartum β‑hCG monitoring are essential to exclude disease recurrence.

The aim of this study was to evaluate the efficacy and toxicity of EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) regimen for the treatment of high-risk gestational trophoblastic neoplasia (GTN). Thirty-three patients with high-risk GTN, scored according to World Health Organization, received 159 EMA/CO treatment cycles between 1994 and 2004. Twenty-three patients were treated primarily with EMA/CO, and 10 patients were treated secondarily after failure of single agent or MAC (methotrexate, actinomycin D, cyclophosphamide, or clorambucile) III chemotherapy. Adjuvant surgery and radiotherapy were used in selected patients. Survival, response, and toxicity were analyzed retrospectively. The overall survival rate was 90.9% (30/33). Survival rates were 91.3% (21/23) for primary treatment and 90% (9/10) for secondary treatment. Six (18.2%) of 33 patients had drug resistance. Four of them underwent surgery for adjuvant therapy. Three of these patients with drug resistance died. Survival and complete response to EMA/CO were influenced by liver metastasis, antecedent pregnancy, and histopathologic diagnosis of choriocarcinoma. Survival rate was also affected by blood group. The treatment was well tolerated. The most severe toxicity was grade 3–4 leukopenia that occurred in 24.3% (8/33) of patients and 6.9% (11/159) of treatment cycles. Febrile neutropenia occurred in one patient (3%). EMA/CO regimen is highly effective for treatment of high-risk GTN. Its toxicity is well tolerated.

Gestational Trophoblastic Neoplasia (GTN) involving the cervix is an uncommon and potentially life-threatening condition that poses significant diagnostic and therapeutic challenges. Early recognition and risk-adapted management are essential to achieve optimal outcomes. We report a 36-year-old woman with a prior history of molar pregnancy who presented with abnormal vaginal bleeding and systemic symptoms suggestive of malignancy. Laboratory evaluation revealed markedly elevated serum β-hCG levels, and imaging demonstrated a hypervascular cervical mass. The diagnosis of GTN involving the cervix was established based on clinical, radiologic, and biochemical findings. The patient was managed with EMA-CO chemotherapy (etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine) as per high-risk GTN protocol. She tolerated the regimen well with only mild adverse effects. Serial β-hCG monitoring demonstrated a consistent decline, and complete remission was achieved after 10 cycles of EMA-CO followed by 2 consolidation cycles. Follow-up imaging confirmed the absence of residual or recurrent disease. This case underscores the effectiveness of EMA-CO chemotherapy in achieving complete remission in high-risk GTN involving the cervix. It highlights the importance of early diagnosis, multidisciplinary coordination, and rigorous post-molar surveillance in improving outcomes for patients with this rare presentation.

Objective To evaluate the clinical outcomes and treatment strategies in patients with gestational trophoblastic neoplasia (GTN) treated at a tertiary care center in North India, with a focus on response to methotrexate-based chemotherapy and the factors influencing the need for escalation to more intensive regimens. Methods A prospective observational study was conducted on 15 patients diagnosed with GTN from June 2023 to June 2024 at a tertiary care center. The mean age of the cohort was 24.6 years. All patients were initially diagnosed following a molar pregnancy, with a mean interval of 4.57 months between the antecedent pregnancy and diagnosis. Treatment regimens primarily included methotrexate and folinic acid (Mtx + FA), with 23.1% of patients requiring escalation to the more aggressive EMA-CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine) regimen due to inadequate response. Lung metastasis was identified as a key factor leading to treatment escalation. Results Of the 15 patients, the majority were initially treated with the Mtx + FA regimen. Approximately 23.1% (n=3) of patients required a switch to the EMA-CO regimen due to insufficient response to the initial treatment. Lung metastasis was a major determinant for escalating therapy in patients who were considered low-risk based on WHO and FIGO staging criteria. Despite these challenges, all patients achieved complete remission, either through initial therapy or after escalation to more aggressive regimens. Conclusion This study underscores the significance of individualized treatment approaches for patients with GTN, particularly in the presence of metastasis, to ensure optimal outcomes. Timely risk stratification based on WHO scoring and FIGO staging is critical in determining the appropriate chemotherapy regimen.

Aims This study aimed to identify the optimal human chorionic gonadotropin (hCG) ratio in predicting etoposide, methotrexate, dactinomycin, cyclophosphamide, and vincristine resistance in women diagnosed with high‐risk gestational trophoblastic neoplasia (GTN) and to compare the chemoresistant disease detection rate by using the optimal hCG ratio and traditional criteria. Methods Seventy‐six women with primary high‐risk GTN treated with etoposide, methotrexate, dactinomycin, cyclophosphamide, and vincristine in a tertiary‐care center were included. The hCG ratio was determined by its serum pretreatment level divided by that before each cycle of chemotherapy. The traditional criteria for chemoresistance included plateau or rising of hCG or presence of new metastasis. The optimal hCG ratio was determined using receiver operating characteristics (ROC) curve analysis. Results Among the specificities of 90%, 92.5%, and 95%, the 90% specificity yielded the best ROC curve. At 90% specificity, the best area under curve value was at the fourth cycle with 75% sensitivity. The hCG ratio at the fourth cycle was 31.92. Using the ratio at the fourth cycle, chemoresistant disease was detected in six out of eight patients, compared to one in the traditional criteria. When combining the two diagnostic tools, the cumulative detection rate in the fourth cycle was 10/12 (83.3%) of total drug resistance. Among patients who developed drug resistance at the fourth cycle or thereafter, the use of the ratio at the fourth cycle could diagnose chemoresistance approximately two cycles earlier than that with the traditional criteria. Conclusions A hCG ratio of <31.9 at the fourth cycle should be considered a high‐risk for etoposide, methotrexate, dactinomycin, cyclophosphamide, and vincristine resistance and may need second‐line chemotherapy. The ratio increases the detection rate of resistance to these drugs more than the traditional criteria.

This study was designed to analyze the outcomes of chemotherapy for high-risk gestational trophoblastic neoplasia (GTN) with EMA-CO regimen as primary and secondary protocol in China. Fifty-four patients with high-risk GTN received 292 EMA/CO treatment cycles between 1996 and 2005. Forty-five patients were primarily treated with EMA-CO, and nine were secondarily treated after failure to other combination chemotherapy. Adjuvant surgery and radiotherapy were used in the selected patients. Response, survival and related risk factors, as well as chemotherapy complications, were retrospectively analyzed. Thirty-five of forty-five patients (77.8%) receiving EMA-CO as first-line treatment achieved complete remission, and 77.8% (7/9) as secondary treatment. The overall survival rate was 87.0% in all high-risk GTN patients, with 93.3% (42/45) as primary therapy and 55.6% (5/9) as secondary therapy. The survival rates were significantly different between two groups (χ2= 6.434, P = 0.011). Univariate analysis showed that the metastatic site and the number of metastatic organs were significant risk factors, but binomial distribution logistic regression analysis revealed that only the number of metastatic organs was an independent risk factor for the survival rate. No life-threatening toxicity and secondary malignancy were found. EMA-EP regimen was used for ten patients who were resistant to EMA-CO and three who relapsed after EMA-CO. Of those, 11 patients (84.6%) achieved complete remission. We conclude that EMA-CO regimen is an effective and safe primary therapy for high-risk GTN, but not an appropriate second-line protocol. The number of metastatic organs is an independent prognostic factor for the patient with high-risk GTN. EMA-EP regimen is a highly effective salvage therapy for those failing to EMA-CO.

Gestational trophoblastic disease usually follows a molar pregnancy but can occur also after an abortion or a term pregnancy. In only 10% of cases will treatment be required; and usually, single-agent chemotherapy will suff ice. In high-risk disease, the multiagent regimen EMA-CO is usually used; and if that fails, most oncologists will use the EMA-EP regimen. If this does not produce a remission, there is no unanimity of opinion as to how to proceed. Numerous salvage regimens are in current use, and some centers do not consider high-dose chemotherapy. A young woman presented 4 months after a normal spontaneous delivery with an elevated human chorionic gonadotropin level and multiple pulmonary metastases. She failed both the EMA-CO and EMA-EP regimens as well as additional standard chemotherapy. She was then treated with 4 separate courses of high-dose chemotherapy with autologous stem cell support, which produced a complete remission. Even patients with high-risk gestational trophoblastic disease are usually cured with standard chemotherapy. Patients who fail such treatment should be considered for high-dose chemotherapy.

Choriocarcinoma is the most malignant tumor of gestational trophoblast origin. Metastasis to brain is considered a poor prognostic indicator. Recent advances in adjuvant radiotherapy and chemotherapy have led to an excellent outcome of these patients. Craniotomy is indicated in selected cases with cerebral metastases. The authors report an interesting case of an aggressive choriocarcinoma with multiple metastases to the brain and viscera. The patient had radiological evidence of new lesions occurring almost every week while on the initial treatment and yet had a complete long-term remission with EMA-CO therapy. The interesting presentation, radiology and adjuvant therapies are discussed.

Purpose To determine the characteristics and outcome of patients with refractory gestational trophoblastic neoplasia (GTN) after primary chemotherapy (CTx). Methods The outcome of low- and high-risk patients with refractory GTN ( n  = 14, 37%) was compared to those with non-refractory GTN ( n  = 24, 63%). Methotrexate treatment was used for patients with low-risk disease and EMA/CO for patients with high-risk disease. Results Median follow-up time was 53 months (range 1–173 months). All non-refractory patients and 11 refractory patients (79%) survived ( p  = 0.015). Factors related to resistance to primary CTx was age ( p  = 0.012), duration between causal pregnancy and initial treatment ( p  = 0.003), surgery ( p  = 0.014), hCG level before CTx ( p  = 0.09) and half-life of hCG ( p  = 0.061). Six out of 10 low-risk refractory patients treated with EMA/CO regimen in the second-line setting had been followed by no evidence of disease. Nine of 38 (24%) patients underwent surgery (TAH ± BSO) for GTN. All of the patients treated with surgery were in the non-refractory group, but none of refractory patients underwent surgery ( p  = 0.014). Conclusions Surgery and EMA/CO regimen are one of the main factors that play a role in the management of refractory low-risk GTN.