The efficacy of chemotherapy plays an important role in the treatment of gestational trophoblastic tumors. On the one hand, chemotherapy is the main treatment for gestational trophoblastic tumors, and for most patients, chemotherapy alone can be used to achieve a cure. On the other hand, the efficacy of treatment is greatly compromised when patients develop drug resistance, which leads to disease progression and is a major lethal factor in gestational trophoblastic tumors. Therefore, the quality level of chemotherapy application is the main factor affecting the efficacy of gestational trophoblastic tumors, which should be given high attention. The construction of a team of specialist oncologists is the trend and is still emerging. Gestational trophoblastic tumor is a rare and highly malignant gynecologic tumor, and its clinical and pathologic characteristics and treatment methods have obvious special features. On the one hand, because it is a rare tumor, even for most gynecologic oncologists, they often see only a few cases each year, making it difficult to accumulate effective experience in diagnosis and treatment. On the other hand, gestational trophoblastic tumors can be treated with excellent results through standard treatment, which makes the poor prognosis caused by non-standard treatment particularly regrettable. In our clinical practice, the vast majority of drug-resistant patients have experienced off-center irregular chemotherapy, some with very serious consequences. Based on the above, it is advisable to advocate that the treatment of gestational trophoblastic tumors, including chemotherapy, should be concentrated in centers with considerable experience and performed by specialists. The treatment of gestational trophoblastic tumor cases scattered in various hospitals should be concentrated in hospitals with better geographical centers and treated by specialists, which is not only conducive to the standardization of treatment, but also conducive to the summation of experience and clinical research, thus improving the diagnosis and treatment of gestational trophoblastic tumor. In the United Kingdom and the United States, for example, due to the strict referral procedure brought by the public funding system, cases of gestational trophoblastic tumors in the United Kingdom are concentrated in two centers for treatment, and the overall efficacy has improved greatly, while in the United States, although there are several gestational trophoblastic tumor treatment centers, there is no mandatory referral system, and many patients are scattered in non-centers for treatment, and the overall efficacy has not improved much. The reason why gestational trophoblastic tumors can achieve good chemotherapeutic effects is closely related to two outstanding features of this tumor, namely, the short multiplication time of tumor cells and the ability to secrete human chorionic gonadotropin (hCG), the former determines that gestational trophoblastic tumors are highly sensitive to chemotherapy, and the latter allows us to be sensitive and specific to chemotherapy. The former determines that gestational trophoblastic tumors are highly sensitive to chemotherapy, and the latter allows us to sensitively and specifically observe changes in tumor load so that we can adjust our treatment strategy accordingly. For any tumor, the choice of chemotherapeutic agents and regimens should be tailored to the characteristics of the tumor itself. Gestational trophoblastic tumor cells have a short multiplication time of approximately 48 hours, which means that their DNA synthesis is very active and therefore extremely sensitive to antimetabolic drugs. From common experience both nationally and internationally, first-line monotherapy for gestational trophoblastic tumors is primarily antimetabolites (e.g., 5-fluorouracil, methotrexate, etc.), and antimetabolites are also a major component of first-line combination chemotherapy regimens. Regimens without antimetabolites are usually second-line regimens, such as some platinum- and paclitaxel-containing regimens, and are mostly used in patients who have failed first-line regimens for drug resistance. It is well known that the success of initial therapy has a major impact on the prognosis of gestational trophoblastic tumors. Unfortunately, in our clinical practice, drug resistance due to the use of chemotherapeutic drugs or irregular chemotherapy regimens at the initial treatment is often seen, as well as the use of randomized chemotherapy regimens for other tumors due to the lack of understanding of the characteristics of gestational trophoblastic tumors, and the use of random combinations of regimens with no provenance. Due to the general chemosensitivity of gestational trophoblastic tumors, any chemotherapeutic agent tends to have a certain degree of efficacy, and because patients with poor outcomes are often referred elsewhere, without rigorous follow-up, users of such regimens tend to overestimate the efficacy of these regimens and the harm they cause will continue. While innovation is encouraged, scientific investigation should follow the principles of clinical research, requiring repeated clinical validation in accordance with the principles of evidence-based medicine and medical ethics. Especially for patients with gestational trophoblastic tumors in primary treatment, it is clearly inappropriate to still choose drugs and regimens without taking into account tumor characteristics, as there are already several chemotherapy regimens with recognized excellent results. In addition to the selection of reasonable drugs, reasonable measures must be followed in the process of their use. In the order of using drugs, cell cycle non-specific drugs should be used first, so that after the tumor cells are killed in large quantities, the cells in quiescent phase will enter the proliferative cycle, and then cell cycle specific drugs will be used afterwards, in order to achieve the best effect of tumor cell killing. In terms of dosing method, anti-metabolic drugs, as cell cycle specific drugs, need to maintain a long effective concentration time to achieve satisfactory therapeutic effect, and are generally administered by intravenous drip for a prescribed time. Before using any chemotherapy regimen, it is best to find out the original literature and study it carefully, so as to understand it thoroughly and without any discount, and avoid reducing the dosage and prolonging the chemotherapy interval arbitrarily, so as not to reduce the efficacy and induce drug resistance. It is worth noting that the chemotherapy interval varies greatly among different regimens and should not be confused. The chemotherapy interval usually refers to the number of days of chemotherapy discontinuation, not the time interval from day 1 of this chemotherapy to day 1 of the next chemotherapy. For regimens such as 5FU+KSM, where the number of days per course of chemotherapy is relatively long, the consequences of misunderstanding the meaning of the chemotherapy interval are often serious, and incidents of severe toxic side effects due to a short chemotherapy interval are not uncommon and should be taken very seriously. In the case of EMA/CO and EMA/EP, the method used is single-week EMA and biweekly CO (or EP) with weekly chemotherapy, not 15 days of CO (or EP) before starting the next round of EMA/CO (EMA/EP). Clinical confusion between the use of MTX for ectopic pregnancy and gestational trophoblastic tumors is also sometimes seen. All of the above can have serious consequences and should never be taken lightly. It is important to note that chemotherapy is the primary, not the only, treatment for gestational trophoblastic tumors, and intravenous administration is not the only route of chemotherapy. The best way to achieve the best efficacy and reduce toxic side effects is to adopt individualized and comprehensive treatment according to the characteristics of patients. Especially for patients with drug-resistant gestational trophoblastic tumors, it is especially important to take comprehensive treatment including surgery. Usually, the physician’s study of the toxic side effects of a chemotherapy regimen is often sketchy compared to the use of the regimen. Especially when we start a new chemotherapy regimen, our knowledge of the potential toxicities is usually far from adequate. The occurrence of toxic side effects not only damages patients’ health and reduces their quality of life, but also causes delays in follow-up treatment, induces chemotherapy resistance, and in severe cases, even directly endangers lives. Moreover, the occurrence of serious toxic side effects can also undermine the confidence of both doctors and patients and affect the effective treatment. As a doctor who is involved in chemotherapy for tumors, he or she should have sufficient knowledge and be able to cope with some common chemotherapy toxic side effects, and should also have in-depth knowledge of some special chemotherapy toxic side effects. Compared with other gynecologic malignancies, chemotherapy regimens for gestational trophoblastic tumors have distinctive chemotherapeutic drug types and/or doses, and thus their toxic side effects also have some different characteristics, which should be adequately recognized and paid attention to. For example, the dysbiosis diarrhea and myocardial damage caused by 5fluorouracil (5FU), the renal tubular damage caused by methotrexate (MTX) and the secondary tumor caused by VP16 are problems that are rarely encountered in chemotherapy for gynecologic malignancies but may be encountered in chemotherapy for gestational trophoblastic tumors. In particular, 5FU may cause dysbiosis diarrhea, which may lead to serious consequences if chemotherapy and/or astringent drugs are not used without adequate knowledge and if appropriate treatment is not taken in time. High doses of MTX require hydration and alkalinization of the urine, and also tetrahydrofolate relief, otherwise serious toxic side effects may occur. There is also the problem of mucosal ulceration due to antimetabolites which is a less common problem in chemotherapy for other gynecologic malignancies. The use of granulocyte colony-stimulating factor (GCSF) has revolutionized the management of granulocytopenia due to chemotherapy, but there are many problems in its use. Some units use GCSF while administering chemotherapy, an unregulated use that risks bone marrow failure of the patient and should be avoided. The normative usage should be at least 24 hours away from chemotherapy and should not be used simultaneously with chemotherapy. In view of the importance of proper recognition and management of toxicities, before using any chemotherapy regimen, in addition to an in-depth understanding and study of the contents of the chemotherapy regimen, one must have a clear understanding of the possible toxicities and have countermeasures to implement individualized treatment in conjunction with specific patient circumstances. Chemotherapy is a systematic project that requires teamwork, communication, cooperation and training. Chemotherapy is a systematic project that requires teamwork, which requires not only a high level of theoretical and practical knowledge of the physician in charge, but also good communication and cooperation among the medical and nursing staff of the department, the medical and nursing staff of the collaborating department, the imaging and laboratory staff and the patients and their families in order to achieve good results. In order to build a good team, we need to first train the medical and nursing staff directly involved in chemotherapy to have a deeper understanding of the special features of chemotherapy for gestational trophoblastic tumors, so that we can start from the details and strengthen the process management to achieve the treatment intention. For example, measures to ensure the accuracy of weight measurement, some rules and meanings of the order/rate/completeness of drug infusion, measures to prevent drug toxicities, etc. need to be repeatedly emphasized and understood before they can be strictly implemented to achieve the desired chemotherapeutic effect. In order to achieve a good treatment effect, the collaboration of the relevant clinical departments is also required. For example, the following three details of pulmonary metastases surgery: 1) the need for concurrent chemotherapy during the perioperative period, which is contraindicated in general surgery: 2) the need for ligation of veins before arteries during lobectomy, whereas the usual surgical procedure is the opposite: 3) the need to give 5FU thoracic injection through the chest drain when it is removed. Then there are the extremely critical patients who sometimes need chemotherapy under intensive care conditions, which is certainly a very challenging and dangerous move. There is also the arterial intervention for gestational trophoblastic tumors, which has many peculiarities that are different from other tumors. Obviously, without good communication and trust, these requirements are very difficult to achieve and optimal outcomes are difficult to obtain. Serum hCG measurement and imaging are important tools to monitor changes in the condition of gestational trophoblastic tumors. Sensitive, reliable and timely measurement of serum hCG is necessary for timely and accurate judgment of changes in disease and efficacy, so that appropriate therapeutic measures can be taken accordingly. The composition, order of magnitude and normal range of serum hCG in pregnant trophoblastic tumor patients are different from those in general pregnancy, and the level of laboratory monitoring technology is directly related to the accuracy of grasping the disease. In chemotherapy, frequent monitoring of blood picture, liver and kidney function is required in order to detect toxic side effects in time and avoid serious consequences. Therefore, it is very important to strengthen communication and cooperation to create a high level of auxiliary department team. Patients and family members are an important party in the chemotherapy team. Not only should patients and families be made to understand the nature of gestational trophoblastic tumors and their curability, so that they can build up confidence in overcoming the disease: they should also be made to understand the problems that may arise in the treatment and how to cooperate with the smooth progress of the treatment, and understand the purpose and significance of the treatment measures taken. For example, if the patient does not understand that 5FU infusion needs to be given at a uniform rate for 6-8 hours, she may adjust the infusion rate on her own, thus affecting the therapeutic effect: if the patient does not understand the special nature of diarrhea caused by chemotherapy, she may take astringent drugs on her own according to common diarrhea: if the patient and/or family members do not know the curability of gestational trophoblastic tumors, some critically ill patients may give up treatment prematurely : and so on. Therefore, strengthening health education efforts and obtaining the understanding and cooperation of patients and families are important measures to ensure the effective implementation of chemotherapy.