Management of high-risk gestational trophoblastic disease

Traditionally in the United States, women have been categorized as having high-risk gestational trophoblastic disease on the basis of traditional risk criteria and have been treated in a similar fashion at most centers. Utilizing more objective and specific scoring systems allows an analysis of the most recently reported results of the treatment of high-risk patients. Identification of the "ultra-high-risk" patient allows a comparison of various therapeutic regimens at different centers. Such an analysis demonstrated the inadequacy of the traditional methotrexate/actinomycin-D/chlorambucil and modified Bagshawe regimens for these patients. Superior results have been achieved utilizing alternative regimens that include VP-16, the most effective new agent.