Introduction/Background GTN is a chemosensitive malignancy with an excellent cure rate. Most women having high risk GTN (HRGTN) are treated with EMACO (etoposide, methotrexate, dactinomycin, cyclophosphamide, and vincristine), however, up to 25% of women with HRGTN have refractory disease & require alternate strategies.

Methodology 74 women with HRGTN treated at our center from 2006 to 2021 were retrospectively analyzed. Patients were initially started on EMACO & those who developed incomplete response or resistance were treated with salvage therapy which included various drug combinations (employing etoposide and platinum agents) and surgery.

Results The mean age of patients was 26.58 ± 6.76 years. Prior pregnancy was molar pregnancy in 33 patients (44.6%), abortion in 32 patients (43.2%), 2 had ectopic pregnancy (2.7%) & 7 had normal delivery (9.45%). Lung metastasis was present in 55 patients (74.32%), 7 had brain metastasis, 4 had vaginal & 3 had liver metastasis. Majority of the patients (66.2%) were in FIGO Stage 3 at the time of diagnosis. All patients received EMACO as the first line chemotherapy, 29 patients (39.2%) developed resistance and received EMA/EP regimen alone in 24 patients and EMA/EP followed by TC in 5 patients. Seventeen patients (23.72%) needed salvage surgery – hysterectomy (12), tumor resection (3) & lung metastatectomy (2) and 7 received brain radiotherapy . Complete response to salvage therapy was seen in 82.5% patients. Majority of patients who received salvage therapy had β-hcg >10⁶ mIU/mL (p= 0.023) & had FIGO score ≥12 (0.021). The patients were followed-up till May 2022 – 3 deceased during the course of treatment, 3 patients had recurrence and 7 patients conceived successfully and delivered a live baby.

Conclusion EMACO as first line chemotherapy and platinum/etoposide-based drug regimens along with surgery as salvage therapy in high risk patients were successful in achieving cure in high-risk GTN patients.