August 2nd, 2021

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Management of High-Risk Gestational Trophoblastic Neoplasia with Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide, Vincristine Chemotherapy
Authors:  S. Cyriac, M.D., R. Rajendranath, M.D., D.M., V. Sridevi, M.S., M.Ch., and T. G. Sagar, M.D., D.M.
  OBJECTIVE: To evaluate the efficacy and toxicity of etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine (EMA-CO) chemotherapy for the treatment of high-risk gestational trophoblastic neoplasia (GTN).

STUDY DESIGN: Thirty-five patients with high-risk GTN were treated with 196 cycles of EMA-CO between 1997 and 2006. Twenty-nine patients received EMA-CO in the primary setting and another 6 after failure of
single-agent chemotherapy. Salvage chemotherapy was offered to selected patients.

RESULTS: Of the 29 patients treated with EMA-CO in the primary setting, 22 (75.8%) had a complete clinical response, 5 (17.1%) progressed, and 2 (7.1%) had early deaths. Three patients relapsed after achieving initial complete response. Five were treated with salvage chemotherapy, of which only 2 survived. This translated to overall survival rate of 71% in the primary setting. Five of the 6 patients treated with EMA-CO as second line are survivors. Life threatening toxicity was not seen after EMA-CO. Nine subsequent normal pregnancies were reported after EMA-CO.

CONCLUSION: EMA-CO was highly effective for the management of high-risk GTN, and the toxicities were minimal. Reproductive outcome after treatment with EMA-CO was excellent.
Keywords:  chemotherapy, EMA-CO protocol, gestational trophoblastic disease, salvage therapy
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