Information for Patients with Molar Pregnancies or Choriocarcinoma
hCG Monitoring during chemotherapy
Whilst treatment is taking place the serum hCG level should be monitored twice a week. The results from this are monitored at Charing Cross Hospital to check if the disease is responding well to treatment and the hCG level falling appropriately as shown in Fig 6. Of the patients who start with Methotrexate treatment approximately 1/3rd will have to change to more intensive treatment. We are able to tell who needs to step-up to more intensive treatment by the pattern of the hCG levels.
If the hCG level rises for 2 consecutive samples or stays much the same for 3 we generally recommend that the next step in intensity of the treatment is used. All patients who need to change to more intensive treatment will be called back to Charing Cross to discuss this and to start the next treatment. As a rough guide when a change from Methotrexate is needed this will be to EMA-CO chemotherapy if the hCG level is over 300 or to Actinomycin D chemotherapy if the hCG level is less than 300. In Fig 7 the hCG results and treatment graph of a patient who started on Methotrexate and then changed over to EMA-Co chemotherapy to successfully complete treatment is shown.