Metastatic choriocarcinoma is considered high-risk when it is diagnosed more than four months after the onset of pregnancy, associated with a serum ßHCG titer greater than 40,000 mIU/mL, liver or brain metastases, a history of chemotherapy or if it occurs after a full-term pregnancy.
Standard Treatment Poor-risk metastatic disease has to be treated as soon as possible with aggressive chemotherapy. Women with brain or liver metastases are often treated with radiation therapy to the brain or liver. Women with liver metastases have the worst prognosis .
Standard chemotherapy has been with MAC, but recently there has been a trend toward using a regimen known as EMA-CO, which includes the drugs etoposide , methotrexate , actinomycin -D , vincristine and Cytoxan .
Other drugs used in women who fail to respond to MAC and/or EMA-CO include vinblastine , cisplatin , bleomycin and ifosfamide . Once a negative ßHCG level is obtained, most women are treated with three more courses of chemotherapy and are then followed with monthly ßHCG titers for two years.
