Surgery and chemotherapy in the management of placental site tumor.

Since 1977 we have managed seven cases of placental site trophoblastic tumor. All patients were treated with hysterectomy. Three patients had preoperative chemotherapy without evidence of response. One of three patients presenting with no evidence of extrauterine spread and one of four presenting with extrauterine pelvic disease have died from metastatic disease on recurrence. One patient with pelvic disease and lung metastases at diagnosis has residual lung nodules, presumed necrotic, 47 months after completing chemotherapy. She received etoposide, methotrexate, and actinomycin D (EMA) alternating weekly with cyclophosphamide and vincristine (CO). Although surgical excision of placental site tumor remains the treatment of choice, EMA/CO chemotherapy may produce the occasional long-term survivor.