高危妊娠滋养层细胞肿瘤的二次化疗  

Secondary chemotherapy for high-risk gestational trophoblastic neoplasia

作　　者：Lurain J.R. Nejad B. 侯巍 

机构地区：[1]John I. Brewer Trophoblastic Dis. C., Dept. of Obstetrics and Gynecology, NW Univ. Feinberg School of Medicine, 333 E. Supe rior Street, Chicago, IL 60611, United States

出　　处：《世界核心医学期刊文摘（妇产科学分册）》2005年第9期26-27,共2页Core Journal in Obstetrics/Gynecology

摘　　要：Objective. To determine the efficacy of secondary chemotherapy after failure o f initial treatment for high-risk gestational trophoblastic neoplasia. Methods. Twenty-six patients with high-risk gestational trophoblastic neoplasia based on WHO criteria who failed primary treatment or relapsed from remission and rece ived secondary chemotherapy were identified from the records of the Brewer Troph oblastic Disease Center. Initial chemotherapy consisted of etoposide, high-dose methotrexate with folinic acid, actinomycin D, cyclophosphamide and vincristine (EMA-CO) in 10 patients and methotrexate/actinomycin D-based chemotherapy wit hout etoposide in 16 patients. Secondary chemotherapy consisted mainly of platin um-etoposide combinations with methotrexate and actinomycin D (EMA-EP), bleomy cin (BEP), or ifosfamide (VIP, ICE). Adjuvant surgery and radiotherapy were used in selected patients. Clinical response and survival as well as factors affecti ng survival were analyzed retrospectively. Results. The overall survival has 61. 5%(16/26). Of the 10 patients who failed primary treatment with EMA-CO, 9 (90 %) had complete clinical responses to secondary chemotherapy with EMA-EP (3) o r BEP (6), and 6 (60%) were placed into lasting remission. Of the 16 patients w ho failed primary treatment with methotrexate/actinomycin D-based chemotherapy without etoposide, 10 (63%) had complete clinical responses to BEP (8), VIP (1) and ICE (1), and 10 (63%) achieved long-term remission. Adjuvant surgical pro cedures were performed on 15 patients as a component of their therapy; eight (73 %) of 11 patients who underwent hysterectomy, five (62%) of eight patients who had pulmonary resections, and one patient who had wedge resection of resistant choriocarcinoma from the uterus survived. Survival was significantly influenced by both hCG level at the start of secondary therapy and sites of metastases. Con clusion. Patients with persistent or recurrent high-risk gestational trophoblas tic neoplasia who develop resistance to methotrexate-conObjective. To determine the efficacy of secondary chemotherapy after failure o f initial treatment for high-risk gestational trophoblastic neoplasia. Methods. Twenty-six patients with high-risk gestational trophoblastic neoplasia based on WHO criteria who failed primary treatment or relapsed from remission and rece ived secondary chemotherapy were identified from the records of the Brewer Troph oblastic Disease Center. Initial chemotherapy consisted of etoposide, high-dose methotrexate with folinic acid, actinomycin D, cyclophosphamide and vincristine (EMA-CO) in 10 patients and methotrexate/actinomycin D-based chemotherapy wit hout etoposide in 16 patients. Secondary chemotherapy consisted mainly of platin um-etoposide combinations with methotrexate and actinomycin D (EMA-EP), bleomy cin (BEP), or ifosfamide (VIP, ICE). Adjuvant surgery and radiotherapy were used in selected patients. Clinical response and survival as well as factors affecti ng survival were analyzed retrospectively. Results. The overall survival has 61. 5%(16/26). Of the 10 patients who failed primary treatment with EMA-CO, 9 (90 %) had complete clinical responses to secondary chemotherapy with EMA-EP (3) o r BEP (6), and 6 (60%) were placed into lasting remission. Of the 16 patients w ho failed primary treatment with methotrexate/actinomycin D-based chemotherapy without etoposide, 10 (63%) had complete clinical responses to BEP (8), VIP (1) and ICE (1), and 10 (63%) achieved long-term remission. Adjuvant surgical pro cedures were performed on 15 patients as a component of their therapy; eight (73 %) of 11 patients who underwent hysterectomy, five (62%) of eight patients who had pulmonary resections, and one patient who had wedge resection of resistant choriocarcinoma from the uterus survived. Survival was significantly influenced by both hCG level at the start of secondary therapy and sites of metastases. Con clusion. Patients with persistent or recurrent high-risk gestational trophoblas tic neoplasia who develop resistance to methotrexate-con

关 键 词：高危妊娠 滋养层细胞 氨甲蝶呤 异环磷酰胺 博来霉素 初次化疗 初次治疗 甲酰四氢叶酸 依托泊苷 楔形切除术 

分 类 号：R737.33[医药卫生—肿瘤]