Randall T C, Coukos G, Wheeler J E, Rubin S C
Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, 19107, USA.
Gynecol Oncol. 2000 Jan;76(1):115-7. doi: 10.1006/gyno.1999.5654.
Placental site trophoblastic tumor (PSTT) is a form of gestational trophoblastic neoplasm that is frequently resistant to chemotherapy. In most cases disease is confined to the uterus and can be cured by curettage or simple hysterectomy. Patients with metastases, however, frequently have progression of disease and die despite aggressive multiagent chemotherapy.
A 31-year-old woman was found on review of uterine curettings to have a PSTT. Imaging studies revealed multiple lung lesions, a liver lesion, and an enlarged irregular uterus. Hysterectomy and staging surgery revealed a large tumor in the endometrial cavity and multiple metastases. She was treated with etoposide-methotrexate-dactinomycin and cyclophosphamide-vincristine and had a complete clinical remission. Six months later, however, she had a recurrence. She was then treated with six cycles of etoposide-methotrexate-dactinomycin and etoposide-cisplatin. Three years after completion of the second regimen she is without evidence of disease.
Treatment with multiagent chemotherapy can produce long-term remission, even in patients with recurrent, metastatic PSTT. Addition of platinum may be helpful in patients who have recurred or progressed after treatment with non-platinum-containing regimens.
胎盘部位滋养细胞肿瘤（PSTT）是妊娠滋养细胞肿瘤的一种形式，常对化疗耐药。在大多数情况下，疾病局限于子宫，可通过刮宫或单纯子宫切除术治愈。然而，有转移的患者尽管接受了积极的多药化疗，疾病仍常进展并导致死亡。
一名31岁女性在子宫刮宫术后检查发现患有PSTT。影像学检查显示肺部有多个病灶、肝脏有一个病灶以及子宫增大且形态不规则。子宫切除术和分期手术显示子宫内膜腔内有一个大肿瘤及多处转移。她接受了依托泊苷-甲氨蝶呤-放线菌素D以及环磷酰胺-长春新碱治疗，并实现了完全临床缓解。然而，6个月后她复发了。随后她接受了6个周期的依托泊苷-甲氨蝶呤-放线菌素D以及依托泊苷-顺铂治疗。在完成第二种治疗方案3年后，她没有疾病迹象。
多药化疗可产生长期缓解，即使是复发性、转移性PSTT患者。对于接受不含铂方案治疗后复发或病情进展的患者，添加铂类药物可能有益。
