Before starting chemotherapy for invasive mole or for non-metastatic and metastatic choriocarcinoma , certain diagnostic tests should be performed including a chest x-ray and a CT scan of the abdomen, pelvis and head. Even when the chest x-ray is normal, a CT scan of the lungs may reveal small metastases in up to 40 percent of women. These women have a 50 percent failure rate with single drug chemotherapy. A complete blood count, platelet count and kidney and liver function tests are also required before initiating chemotherapy.
An important aspect of treating women with GTD is to start therapy as quickly as possible after the diagnosis is made. It is also important to give chemotherapy as often as possible until the serum ßHCG titers return to normal. A course of chemotherapy is generally given every 14 to 21 days, depending on the drug regimen used.
Depending on the extent of the disease, most physicians give one to three cycles of chemotherapy after the first normal, ßHCG level, then follow the titers monthly for 6 to 24 months after treatment. All women are advised to use oral contraceptives for one to two years after therapy.
