Patel Shilpa M, Desai Ava
Department of Gynecologic Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India.
J Reprod Med. 2010 Jul-Aug;55(7-8):296-300.
To determine the outcome of secondary management in drug-resistant gestational trophoblastic neoplasia (GTN).
Sixteen of 60 patients with GTN (8 low-risk and 8 high-risk) who developed resistance to primary chemotherapy were studied retrospectively. Primary chemotherapy was methotrexate-folinic acid rescue (MTX-FA) for low risk and etoposide/methotrexate/actinomycin D/cyclophosphamide/vincristine (EMA-CO) for high risk. Secondary chemotherapy for the low-risk group was either actinomycin D or EMA-CO, depending on serum beta human chorionic gonadotropin (hCG) levels at resistance. For the high-risk group, etoposide/methotrexate/actinomycin D/cisplatinum (EMA-EP) or bleomycin/etoposide/cisplatin (BEP) was given. Third-line chemotherapy was vincristine/actinomycin D/cyclophosphamide (VAC) or vincristine/ iphosphamide/cisplatin (VIP). Surgery and radiotherapy were used in selected patients.
Survival after salvage therapy in low-risk patients was 100%: 2 with EMA-CO and 6 with actinomycin D. Of high-risk cases 75% were cured with EMA-EP or BEP. Third-line chemotherapy was given in 2 patients: 1 was lost to follow-up and the other died. Survival was significantly influenced by both hCG level at the start of secondary therapy and site of metastasis.
Prognosis in GTN is excellent. Optimization of treatment strategies for those who develop drug resistance remains a key challenge.
确定耐药性妊娠滋养细胞肿瘤（GTN）二次治疗的结果。
回顾性研究60例GTN患者中16例（8例低危和8例高危）对一线化疗产生耐药的情况。一线化疗中，低危患者采用甲氨蝶呤-亚叶酸解救方案（MTX-FA），高危患者采用依托泊苷/甲氨蝶呤/放线菌素D/环磷酰胺/长春新碱方案（EMA-CO）。低危组的二线化疗根据耐药时血清β人绒毛膜促性腺激素（hCG）水平，采用放线菌素D或EMA-CO。高危组给予依托泊苷/甲氨蝶呤/放线菌素D/顺铂方案（EMA-EP）或博来霉素/依托泊苷/顺铂方案（BEP）。三线化疗采用长春新碱/放线菌素D/环磷酰胺方案（VAC）或长春新碱/异环磷酰胺/顺铂方案（VIP）。部分患者采用了手术和放疗。
低危患者挽救治疗后的生存率为100%：2例采用EMA-CO，6例采用放线菌素D。高危病例中，75%通过EMA-EP或BEP治愈。2例患者接受了三线化疗：1例失访，另1例死亡。二次治疗开始时的hCG水平和转移部位均对生存率有显著影响。
GTN的预后良好。优化对耐药患者的治疗策略仍然是一项关键挑战。
