Choriocarcinoma is extremely chemo sensitive; cure is possible even in metastatic disease. All patients with choriocarcinoma should undergo a careful pre-treatment evaluation for proper staging and risk stratification.
Treatment is based on disease stage and risk score. Patient with stage l disease usually have a low risk score, and those with stage IV disease have a high risk score
Please refer to image number 1.
Stage I and low risk stage II&III patients are treated with single agent as shown in table
Note: if no response to single agent, give combination drugs. Stage IV and high risk stage II & III patients receive combination chemotherapy.
The current standard regimen for combination therapy is EMA–CO with dose and schedule as shown below.
• Cycles are repeated after every 14 days until β–hCG is normal
• Surgery and/or radiotherapy may be considered in some cases of metastasis
• Weekly measurement of hcg level until they are normal for 3 consecutive weeks
• Monthly hcg levels until levels are normal for 12 consecutive months
• Effective contraception during the entire period of hormonal follow–up
Signs and Symptoms
• Serum β-hCG level
• LFT, RFT, TSH, T3, T3
• CXR and or CT Scan
• Abdominal and Pelvic USS or CT Scan
• Brain MRI
• Tissue sample for histology
• CSF hCG level
5 Novemba 2020 10:08:27