In a patient with high-risk gestational trophoblastic neoplasia, how would you approach treatment of recurrence at 6 months post EMA-CO?

NCCN guidelines recommend EMA-EP (etoposide, methotrexate, actinomycin-d alternating with etoposide and cisplatin) for patients who have recurrence after a complete response to EMA-CO. Given the pulmonary metastases, I would not recommend hysterectomy as initial therapy. However, if the patient had ...