Treatment of high-risk choriocarcinoma.

Risk has different meanings even within the confines of trophoblastic disease. One unquantifiable risk for patients is treatment by physicians or surgeons with limited knowledge of this rare disease and its modern management. Risk can be immediate at the time of presentation because the disease has sometimes progressed to a life-threatening state before the diagnosis is established. Special problems at that time need consideration on the basis of which organs are involved. Placental-site trophoblastic disease presents distinctive features and requires different management. A major long-term risk is drug resistance, and a high proportion of late treatment failures in choriocarcinoma arise from inappropriate therapy at an early stage in treatment. "Prognostic," or "risk," scoring identifies the propensity of a tumor to become resistant to chemotherapy and enables treatment to be planned from the outset to minimize that risk.