Support for high and ultra high risk GTNs

SOGC/GOC Clinical Guideline #408, January 2021

High Risk GTN

  • The 2 commonly used protocols with a high cure rate and an acceptable toxicity profile are EMA-CO and EMA-EP.
  • The toxic effects of concern are myelosuppression (G-CSF), alopecia, mucositis and secondary malignancies.
  • Weekly hCG monitoring should continue until the serum hCG level normalizes.
  • Consolidation chemotherapy after normalization of serum hCG level continues for 6 weeks (3 cycles)

Ultra High Risk GTN

  • Low-dose induction chemotherapy (etoposide and cisplatin 1 to 3 wk) followed by EMA-EP (liver metastasis) or EMA-CO reduces the rate of early death (< 4 wk).
  • Consolidation chemotherapy after normalization of serum hCG level continues for 8 weeks (4 cycles)
  • Adjunctive treatments to systemic treatment may prove necessary: ​​embolization, radiotherapy, surgery, craniotomy, thoracotomy, intensive care within the framework of highly specialized teams.
  • The potential for cure in high-risk patients is 70-95%.
  • Previously, patients with ultra-high-risk disease were at risk of early death (< 4 wk), with only a 25-50% survival rate. If treated with induction chemotherapy, these ultra-high-risk patients now have a similar prognosis to patients with high-risk disease.

2021. Guideline No. 408: Management of Gestational Trophoblastic Diseases. Eiriksson L, Dean E, Sebastianelli A, Salvador S, Comeau R, Jang JH, Bouchard-Fortier G, Osborne R, Sauthier Ph. J Obstet Gynaecol Can;43(1):91-105.

Modified on 12/23/2023