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Drug therapy of gestational trophoblastic disease

Drug therapy for trophoblastic tumors is centralized to the Norwegian Radium Hospital. Trophoblastic tumors are very sensitive to chemotherapy and the patient is cured in most cases. Fertility can almost always be preserved.

The choice of therapy depends on the extent of the disease. Low risk patients are treated with low-dose methotrexate. If adequate effect is not achieved, this is changed to dactinomycin, which is usually given for 2 -3 courses after normalization of s-hCG (hCG <1). If resistance to these drugs develops, combination chemotherapy is given. Patients in the low risk group are hospitalized for about 1 week for the first admittance. The treatment duration is about 3 months. 

High risk patients are treated with combination chemotherapy. For extensive lung metastases and metastases to the brain or liver, 1-2 courses of low-dose methotrexate are given before combination treatment, to avoid extensive tumor necrosis. The most common combination treatment is EMA-CO. The treatment continues normally for 6-8 weeks after normalization of  s-hCG (hCG <1). Patients in the high risk group are hospitalized for about 2-3 weeks at the first admittance. The treatment duration may be 4- 6 months, or longer.


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