Ngan Sarah, Seckl Michael J
Department of Medical Oncology, Imperial College, Charing Cross Hospital, London, UK.
Curr Opin Oncol. 2007 Sep;19(5):486-91. doi: 10.1097/CCO.0b013e3282dc94e5.
Gestational trophoblastic neoplasia represents the malignant end of the gestational trophoblastic disease spectrum. This review updates readers on developments in the management of gestational trophoblastic neoplasia over the past few years.
Progress has been made in elucidating the genetic changes that give rise to gestational trophoblastic neoplasia. The importance of accurate human chorionic gonadotrophin monitoring and the types of human chorionic gonadotrophin produced in cancer are also topical. Fortunately, most patients are cured with chemotherapy, and the choice of treatment schedule according to low-risk and high-risk prognostic groups is relatively unchanged. Indeed, most patients with low-risk gestational trophoblastic neoplasia are treated with single agent chemotherapy, and those who have high-risk disease with combination chemotherapy using etoposide, methotrexate and actinomycin D, alternating with cyclophosphamide and oncovine. For resistant disease, new paclitaxel-containing regimens appear better tolerated than etoposide and cisplatin alternating weekly with etoposide, methotrexate and actinomycin D.
Prognosis in gestational trophoblastic neoplasia is now excellent following treatment. Virtually all patients with low-risk disease are cured, and survival is now 86% in high-risk patients. Optimization of treatment strategies for those who develop drug resistance remains a key challenge.
妊娠滋养细胞肿瘤代表了妊娠滋养细胞疾病谱的恶性结局。本综述向读者介绍过去几年妊娠滋养细胞肿瘤管理方面的进展。
在阐明导致妊娠滋养细胞肿瘤的基因变化方面取得了进展。准确的人绒毛膜促性腺激素监测的重要性以及癌症中产生的人绒毛膜促性腺激素类型也是热门话题。幸运的是，大多数患者通过化疗治愈，根据低风险和高风险预后组选择治疗方案相对没有变化。确实，大多数低风险妊娠滋养细胞肿瘤患者接受单药化疗，而那些高风险疾病患者则使用依托泊苷、甲氨蝶呤和放线菌素D联合化疗，与环磷酰胺和长春新碱交替使用。对于耐药疾病，含紫杉醇的新方案似乎比依托泊苷和顺铂每周交替使用依托泊苷、甲氨蝶呤和放线菌素D耐受性更好。
妊娠滋养细胞肿瘤治疗后的预后现在非常好。几乎所有低风险疾病患者都能治愈，高风险患者的生存率现在为86%。优化对出现耐药的患者的治疗策略仍然是一个关键挑战。
