Treatment
All patients were evaluated upon admission at our institution and underwent examination, blood routine testing, serum biochemistry, pre-therapy serum human chorionic gonadotrophin (hCG) assays, brain magnetic resonance imaging (MRI), pelvis MRI, chest X-ray, and computed tomography (CT) scans of the chest and abdomen. Brain MRI or CT was also performed if patients had neurological symptoms during treatment. Patients were prospectively assigned a FIGO stage and risk score6.
Chemotherapy was delivered according to standard protocols. First-line multiple-agent chemotherapy was the EMA-CO regimen (etoposide, methotrexate, actinomycin-D/cyclophosphamide, vincristine). For patients who did not respond to the EMA-CO regimen, salvage chemotherapy regimens were considered, including EMA-EP (etoposide, methotrexate, actinomycin-D/etoposide, cisplatin) and TP/TE (paclitaxel, cisplatin/paclitaxel, etoposide). Two to four consolidation courses were given after normalization of serum β-hCG. Furthermore, intrathecal methotrexate (12.5 mg 6) was injected on day 8, combined with systemic EMA-CO or EMA-EP chemotherapy for GTN patients with brain metastases, until normalization of the serum and cerebrospinal fluid (CSF) β-hCG. To minimize long-term toxicity, patients did not receive whole-brain radiotherapy as part of their routine management.