Low Risk GTN
Inj. Methotrexate 1 mg/kg on days 1, 3, 5, 7.

Inj. Folinic acid 0.1 mg/kg on days 2, 4, 6, 8, to be repeated every 14 days till normal bHCG levels which is followed by one additional cycle.

High Risk GTN
EMACO regimen

Day 1
• Inj. Etoposide 100 mg/m2 I/V infusion over 30 min
• Inj. Methotrexate 100 mg/m2, IV bolus, 200 mg/ m2 IV infusion over 12 hrs
• Inj. Actinomycin D 350 mg/ m2 IV bolus

Day 2
• Inj Etoposide 100 mg/m2 IV infusion over 30 min
• Inj. Actinomycin D 350 mg/m2 IV bolus
• Inj. Folinic acid 15 mg IM every 12 hrs for 4 doses, beginning 24 hrs after Methotrexate infusion

Day 7
• Inj. Cyclophosphamide 600 mg/m2 IV infusion
• Inj. Vincristine 1 mg/m2 IV bolus
To be repeated weekly till normal bHCG, which is followed by one additional cycle.
• Second line therapy for persistent disease- EMA-EP containing cisplatin and Etoposide.

Metastatic GTN
Brain metastasis

Modified EMACO with Inj. Methotrexate 1gm/m2 as a 24 hours infusion and folinic acid 30 mg every 12 hours iv or oral 6 doses after completion of methotrexate infusion with whole brain irradiation 3000cGy, in fractions of 300 cGy.

OR

Intrathecal Methotrexate 12.5 mg every 2 weeks.

Liver metastasis
EMACO regimen
If not responding to systemic chemotherapy
Selective chemoembolisation and hepatic resection.