Indications for instituting single-agent chemotherapy following evacuation of a hydatidiform mole usually include
(Mishell, 3/e, pp 455-456.) Single-agent chemotherapy is usually instituted if levels of hCG remain elevated 8 weeks after evacuation of a hydatidiform mole. Approximately 50% of the patients who have persistently high hCG titers will develop malignant sequelae. If hCG titers rise or reach a plateau for 2 to 3 successive weeks following molar evacuation, a single-agent chemotherapy should be instituted, provided that the trophoblastic disease has not metastasized to the liver or brain. The presence of such metastases usually requires initiation of combination chemotherapy.
A rise in hCG titers
A plateau of hCG titers for 1 week
Return of hCG titer to normal at 6 weeks after evacuation
Appearance of liver metastasis