Indications for chemotherapy:
(1) presence of choriocarcinoma
(2) presence of metastases
(2a) brain
(2b) liver
(2c) gastrointestinal tract
(2d) lung > 2 cm in diameter
(2e) vulvar or vaginal AND serum HCG rising or plateaued (NOT falling)
(3) presence of elevated serum human chorionic gonadotrophin (HCG) concentrations
(3a) rising serum HCG in 2 consecutive samples after evacuation of the tumor
(3b) elevated serum HCG levels showing a plateau in 3 consecutive samples after evacuation of the tumor
(3c) serum HCG > 20,000 IU/L 4 weeks or more after evacuation of the tumor
(3d) any elevation of serum HCG at 6 months after evacuation of the tumor (even if declining)
(4) significant hemorrhage (vaginal, gastrointestinal, intraperitoneal, other)
