Initial management of stage I (nonmetastatic) PSTT or ETT

Nonmetastatic PSTT or ETT is defined as FIGO stage I GTN (refer to inset).

All patients are followed with weekly hCG levels until normal (<5 mIU/mL) for three weeks and then monthly until 12 months of normal hCG levels have been documented.

PSTT: placental site trophoblastic tumor; ETT: epithelioid trophoblastic tumor; FIGO: International Federation of Gynecology and Obstetrics; GTN: gestational trophoblastic neoplasia; ActD: dactinomycin; hCG: human chorionic gonadotropin.

* Case reports indicate that local resection may be successful in carefully selected patients who wish to preserve fertility; however, hysterectomy remains the optimal treatment in most cases.

¶ Given the high risk of recurrence and poor survival for such patients, chemotherapy is typically with etoposide plus cisplatin with etoposide, methotrexate, plus ActD ("EP/EMA") followed by pembrolizumab.

Inset table reproduced from: Berkowitz RS, Goldstein DP. Current management of gestational trophoblastic diseases. Gynecol Oncol 2009; 112:654. Original table modified for this publication. Table used with the permission of Elsevier Inc. All rights reserved.

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Initial management of stage I (nonmetastatic) PSTT or ETT