Division of Gynecologic Oncology, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta, Canada.
Gynecol Oncol. 2012 Mar;124(3):553-7. doi: 10.1016/j.ygyno.2011.10.036. Epub 2011 Nov 9.
The objective of this study is to examine the outcomes of combined chemotherapy using methotrexate and dactinomycin in the management of women with low-risk gestational trophoblastic neoplasia (GTN). The primary outcome is the total number of cycles of chemotherapy required to achieve a normal level of human chorionic gonadotropin (hCG). The secondary outcome is treatment-related toxicity.
A retrospective chart review of all patients with GTN treated between 1996-2007 and 1991-2007 was performed at the Alberta Cross Cancer Institute and the British Columbia Cancer Agency, respectively. Patients with low-risk GTN, treated with 0.6 mg/m(2) dactinomycin (days 1 and 2) and methotrexate 100mg/m(2) were included. Toxicities were graded using the National Cancer Institute Common Terminology Criteria for Adverse Events. The number of cycles to achieve normalization of hCG was determined, and multivariate analyses were performed to identify factors associated with treatment duration.
One hundred women were eligible. The average age was 29 years (range 15-46). The median number of cycles to achieve a normal hCG was 3 (range 1-11). Two patients required second-line treatment and one patient chose to proceed with hysterectomy. Ninety-eight percent of patients were primarily cured with this regimen, and 2 were cured with second line treatment. Grade 3 and 4 hematologic toxicities were experienced by 12% and 8% of patients, respectively. Grade 2 and 3 stomatitis or mucositis were noted in 44% and 3% of patients, respectively.
Low-risk GTN is reliably and rapidly cured with combined methotrexate-dactinomycin. Toxicity is modest.
本研究旨在探讨甲氨蝶呤联合放线菌素 D 化疗治疗低危妊娠滋养细胞肿瘤（GTN）患者的疗效。主要结局指标是达到人绒毛膜促性腺激素（hCG）正常水平所需的化疗周期总数。次要结局指标是治疗相关毒性。
分别在艾伯塔省癌症联合会和不列颠哥伦比亚癌症署对 1996-2007 年和 1991-2007 年期间接受治疗的所有 GTN 患者进行回顾性图表审查。纳入接受 0.6mg/m²放线菌素 D（第 1 和第 2 天）和甲氨蝶呤 100mg/m²治疗的低危 GTN 患者。采用国家癌症研究所常见不良事件术语标准对毒性进行分级。确定达到 hCG 正常化所需的周期数，并进行多变量分析以确定与治疗持续时间相关的因素。
共有 100 名女性符合条件。平均年龄为 29 岁（范围 15-46 岁）。达到 hCG 正常所需的中位数周期数为 3（范围 1-11）。2 名患者需要二线治疗，1 名患者选择进行子宫切除术。98%的患者采用该方案得到了初步治愈，2 例患者通过二线治疗得到治愈。分别有 12%和 8%的患者出现 3 级和 4 级血液学毒性，44%和 3%的患者分别出现 2 级和 3 级口腔炎或黏膜炎。
低危 GTN 采用甲氨蝶呤联合放线菌素 D 治疗可快速、可靠地治愈。毒性适度。
