Izhar Raisa
Department of Obstetrics and Gynaecology, Ayub Medical College and Teaching Hospital Complex, Abbottabad.
J Ayub Med Coll Abbottabad. 2003 Apr-Jun;15(2):45-8.
Choriocarcinoma is a highly malignant tumour which originates in developing trophoblast of pregnancy, most commonly following molar pregnancy. It is a potentially fatal disease, but current management protocols have turned the prognosis highly favourable.
This study was done on patients with gestational choriocarcinoma presenting to Gynae-B unit of Khyber Teaching Hospital Peshawar, between May, 1996 to December, 1997, diagnosed on the basis of clinical course and elevated level of HCG. Metastatic evaluation of the disease was done to assign different risk groups to the patients before selecting appropriate chemotherapy regimen for each patient. Results of the therapy were monitored by serial estimation of HCG levels.
During this period 5 patients of choriocarcinoma were treated. In 2 (40%) cases choriocarcinoma developed after molar pregnancy whereas in 3 (60%) cases antecedent pregnancy resulted in spontaneous abortion. Four (80%) patients were from poor socioeconomic class, 3 (60%) were above 39 years of age and 4 (80%) were multiparous. Two patients (40%) were medium risk and 3 (60%) were high risk cases. There was no patient with low risk disease. EMA-CO (Etoposide, Methotrexate, Actinomycin-D, Cytocine, Oncovine) regimen was administered to all patients. Maximum number of cycles of chemotherapy given was 8. Only one patient developed drug resistance. Overall cure rate was 80% (4 patients survived out of 5 at two years' follow-up).
Prognosis of gestational choriocarcinoma is favourable provided the appropriate therapy is administered early in the course of disease. Provision of free medical care should be considered for these patients to save their lives.
绒毛膜癌是一种高度恶性的肿瘤，起源于妊娠时发育中的滋养层，最常见于葡萄胎妊娠之后。它是一种潜在的致命疾病，但目前的治疗方案已使预后大为改观。
本研究针对1996年5月至1997年12月期间在白沙瓦开伯尔教学医院妇科B区就诊的妊娠性绒毛膜癌患者进行。根据临床病程和人绒毛膜促性腺激素（HCG）水平升高进行诊断。在为每位患者选择合适的化疗方案之前，对该疾病进行转移评估以将不同风险组分配给患者。通过连续测定HCG水平监测治疗结果。
在此期间，5例绒毛膜癌患者接受了治疗。2例（40%）绒毛膜癌发生在葡萄胎妊娠之后，而3例（60%）既往妊娠导致自然流产。4例（80%）患者来自社会经济地位低下阶层，3例（60%）年龄超过39岁，4例（80%）为经产妇。2例患者（40%）为中度风险，3例（60%）为高风险病例。没有低风险疾病的患者。所有患者均接受EMA-CO（依托泊苷、甲氨蝶呤、放线菌素-D、环磷酰胺、长春新碱）方案治疗。化疗的最大周期数为8个。仅1例患者出现耐药。总体治愈率为80%（5例患者中有4例在两年随访中存活）。
妊娠性绒毛膜癌只要在疾病早期给予适当治疗，预后良好。应为这些患者考虑提供免费医疗以挽救他们的生命。
