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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.

OBJECTIVESTo assess the importance of salvage therapy in the management of high-risk gestational trophoblastic neoplasia (HR GTN) after failure of first line multiagent chemotherapy. METHODSThis retrospective study involving women with HR GTN treated at Kidwai cancer institute from 2000 to 2015. Initial chemotherapy consisted of etoposide, methotrexate with folinic acid, actinomycin D, cyclophosphamide and vincristine (EMA-CO). Thirty one patients who had incomplete response or relapsed were treated with various drug combinations employing etoposide and platinum agents. Adjuvant surgery and radiation were used in selected patients. Clinical response, survival and factors affecting outcomes were analysed. RESULTSThirty one (37.8%) of the 82 patients developed resistance or relapsed after EMA-CO.Of these 25 (80.6%) had lasting complete response to salvage therapy. Salvage chemotherapy included, EMA EP alone in-15, EMA EP followed with BIP in-1, EMAEP followed with VAC in-2, EMA EP followed by TC and VAC in-1, EMA EP followed by TC in-6, TC followed by IA in-1 patient. Irradiation was given to 6 patients for brain metastasis, 1 for spine metastasis, 1 for pelvic tumor, and 1 for mediastinal mass. Operative procedures were hysterectomy in 9, conservative uterine tumour resection in 4 and excision of resistant lung lesion in one. Median follow up 25 (80.6%) patients was 2 years. Complete response to salvage therapy was seen in 25 (80.6%) patients. Overall survival after salvage therapy was 87.1% with median follow up of 2 years. Remission and survival was significantly influenced by βhCG level at the start of salvage therapy (p<0.001 and 0.006) but not with the stage or with WHO score. CONCLUSIONSSalvage therapy with platinum/etoposide based drug regimens in conjunction with surgery and radiation, was successful in achieving significant cure and survival in HR-GTN patients.