Complete response to multidisciplinary therapy in a patient with primary gastric choriocarcinoma

Figure 3 Tumor markers and chemotherapy. Seven days after surgery, metastatic recurrence in the liver was diagnosed. After starting etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMA/CO), serum beta-human chorionic gonadotropin (β-hCG) concentrations decreased. After three cycles, serum β-hCG levels decreased markedly to almost within normal limits and clinically the tumors showed a complete response. Six months later, there was a sudden elevation in serum β-hCG levels with the emergence of multiple nodules in both lung fields. Metastatic recurrence in the lung was diagnosed and EMA/CO was restarted. After one cycle, most tumors, except for one nodule in the left lower lobe, disappeared concomitantly with declines in serum β-hCG levels. Computed tomography-guided radiofrequency ablation (RFA) was performed for the oligometastatic tumor. The patient has been alive with no evidence of disease for nine years after RFA.