A total score of less than 8 is defined as low risk, 8-12 is medium risk and greater than 12 is high risk for treatment failure. 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.
Chemotherapy is given until the serum hCG titer returns to normal.
Depending on the extent of the disease, most physicians give one to three cycles of chemotherapy following the first normal HCG level, then follow the titers monthly for 6 to 24 months after treatment. All women are advised to use oral contraceptives to prevent pregnancy for one to two years after therapy. RH immune globulin is given to women with Rh negative blood to prevent Rh sensitization. Occasionally the cysts can rupture, bleed or become infected. In the vast majority of cases, these cysts do not have to be removed because they resolve with time, although sometimes it can take several weeks or months for them to disappear completely.