A 40-year-old woman complains of irregular bleeding for 7 months after delivery of her fourth baby. Curettage is performed and histology reveals a choriocarcinoma. Her serum beta hCG level is 2x105 IU/L.What is the most appropriate next step in the management?
Commence treatment with intramuscular methotrexate Commence treatment with multi-agent combination chemotherapy Perform a hysterectomy Repeat serum hCG after 4 weeks