Lurain John R
John I . Brewer Trophoblastic Disease Center, Department of Obstetrics and Gynecology, Northwestern University Medical School, 333 East Superior Street, Chicago, IL 6061, USA.
J Reprod Med. 2002 Jun;47(6):451-9.
Multimodality therapy with combination chemotherapy employing etoposide, high-dose methotrexate, actinomycin D, cyclophosphamide and vincristine and adjuvant radiotherapy and surgery, when indicated, has resulted in cure rates of 80-90% in patients with high-risk metastatic gestational trophoblastic tumors. However, 25-30% of high-risk patients will have an incomplete response to first-line chemotherapy or will relapse from remission. Most of these patients will have a clinicopathologic diagnosis of choriocarcinoma, multiple metastases to sites other than the lung and vagina, and failed or inappropriate previous chemotherapy, resulting in very high World Health Organization scores. Salvage chemotherapy with cisplatin/etoposide, usually in conjunction with bleomycin or ifosfamide, as well as surgical resection of sites of resistant disease in selected patients, will result in a cure for most patients. Colony-stimulating factors should be used to prevent treatment delays and dose reductions. Newer anticancer agents, such as paclitaxel and gemcitibine, and high-dose chemotherapy with or without autologous bone marrow transplantation or peripheral blood stem cell support may play a role in the future management of selected patients.
对于高危转移性妊娠滋养细胞肿瘤患者，采用依托泊苷、大剂量甲氨蝶呤、放线菌素D、环磷酰胺和长春新碱联合化疗以及必要时辅助放疗和手术的多模式治疗，已使治愈率达到80% - 90%。然而，25% - 30%的高危患者对一线化疗反应不完全或会从缓解状态复发。这些患者大多会有绒毛膜癌的临床病理诊断，有肺和阴道以外部位的多处转移，且既往化疗失败或不恰当，导致世界卫生组织评分非常高。采用顺铂/依托泊苷进行挽救性化疗，通常联合博来霉素或异环磷酰胺，以及对部分患者进行耐药病灶的手术切除，将使大多数患者治愈。应使用集落刺激因子来防止治疗延迟和剂量减少。新型抗癌药物，如紫杉醇和吉西他滨，以及有或无自体骨髓移植或外周血干细胞支持的大剂量化疗，可能在未来对部分患者的治疗中发挥作用。
