High-risk GTN with brain metastases — multidisciplinary management station

Multidisciplinary emergency station on ultra-high-risk gestational trophoblastic neoplasia with brain metastases. Tests the recognition of GTN after non-molar pregnancy, the WHO score, the induction-etoposide principle to avoid tumour lysis, EMA-CO, brain radiotherapy, and the team coordination with the trophoblast centre. Includes assessor key and marking domains.

Prompt

A 27-year-old woman presents six weeks after a term vaginal delivery with a two-week history of headache, two episodes of haemoptysis, and a serum hCG of 95,000 IU/L. A CT brain shows three haemorrhagic metastases. Her WHO prognostic score is 13. You are the gynaecology oncology registrar coordinating with the medical oncologist and the trophoblast centre.

Station brief

Format. Multidisciplinary management station, approximately 12 minutes. You are the gynaecology oncology registrar. A medical oncologist, the trophoblast centre coordinator, and a radiation oncologist are available by phone; the consultant is 20 minutes away. The assessor will run the clock and feed you new information. ^[1]

Candidate instruction. Confirm the diagnosis and risk-stratify, then lead the immediate and definitive management of ultra-high-risk gestational trophoblastic neoplasia with brain metastases. Verbalise your reasoning, your drug orders with doses, the induction principle, and your communication with the team, the trophoblast centre, and the woman. ^[1]

References5Show

[1]Ngan HYS, Seckl MJ, Berkowitz RS, Xiang Y, Golfier F, Sekharan PK, Braga A, Garrett A Diagnosis and management of gestational trophoblastic disease: 2025 update. Int J Gynaecol Obstet, 2025.PMID 40631439
[2]Alifrangis C, Agarwal R, Short D, Fisher RA, Sebire NJ, Harvey R, Savage PM, Seckl MJ EMA/CO for high-risk gestational trophoblastic neoplasia: good outcomes with induction low-dose etoposide-cisplatin and genetic analysis. J Clin Oncol, 2013.PMID 23233709
[3]Soper JT Gestational Trophoblastic Disease: Current Evaluation and Management. Obstet Gynecol, 2021.PMID 33416290
[4]FIGO Oncology Committee FIGO staging for gestational trophoblastic neoplasia 2000. FIGO Oncology Committee. Int J Gynaecol Obstet, 2002.PMID 12065144
[5]Ghorani E, Kaur B, Fisher RA, Short D, Joneborg U, Carlson JW, Akarca A, Marafioti T, Quezada SA, Sarwar N, Seckl MJ Pembrolizumab is effective for drug-resistant gestational trophoblastic neoplasia. Lancet, 2017.PMID 29185430

High-risk GTN with brain metastases — multidisciplinary management station

Station brief

References5Show

[1]Ngan HYS, Seckl MJ, Berkowitz RS, Xiang Y, Golfier F, Sekharan PK, Braga A, Garrett A Diagnosis and management of gestational trophoblastic disease: 2025 update. Int J Gynaecol Obstet, 2025.PMID 40631439
[2]Alifrangis C, Agarwal R, Short D, Fisher RA, Sebire NJ, Harvey R, Savage PM, Seckl MJ EMA/CO for high-risk gestational trophoblastic neoplasia: good outcomes with induction low-dose etoposide-cisplatin and genetic analysis. J Clin Oncol, 2013.PMID 23233709
[3]Soper JT Gestational Trophoblastic Disease: Current Evaluation and Management. Obstet Gynecol, 2021.PMID 33416290
[4]FIGO Oncology Committee FIGO staging for gestational trophoblastic neoplasia 2000. FIGO Oncology Committee. Int J Gynaecol Obstet, 2002.PMID 12065144
[5]Ghorani E, Kaur B, Fisher RA, Short D, Joneborg U, Carlson JW, Akarca A, Marafioti T, Quezada SA, Sarwar N, Seckl MJ Pembrolizumab is effective for drug-resistant gestational trophoblastic neoplasia. Lancet, 2017.PMID 29185430