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.