Treatment and prognosis of metastatic gestational trophoblastic disease

Three cases with metastasized choriocarcinoma are reported. The basic chemotherapeutic regimen was methotrexate and actinomycin D, combined with cyclophosphamide or vinblastine. Surgery was used in the treatment of both primary and metastatic lesions. The chief indications for hysterectomy arise when chemotherapy has obviously failed. Thoracotomy was performed for a pulmonary metastasis and nephrectomy for a metastasis of the kidney. Craniotomy was performed to control the brain hemorrhage. Aggressive multidrug chemotherapy is considered necessary as the primary treatment for high-risk cases of trophoblastic disease.