IRCCS San Raffaele Hospital, Obstetrics and Gynecology Department, Vita-Salute University, Milan, Italy.
Ultrasound Obstet Gynecol. 2012 Jul;40(1):99-105. doi: 10.1002/uog.11097.
Methotrexate (MTX) resistance is defined on the basis of the human chorionic gonadotropin (hCG) curve. The aim of this study was to identify low-risk non-metastatic patients with gestational trophoblastic neoplasia (GTN) who can achieve resolution by continuing MTX treatment despite a transient hCG plateau.
Before starting chemotherapy, 24 patients with FIGO Stage I GTN underwent transvaginal ultrasonography with power Doppler in order to identify myometrial lesions (areas of increased echogenicity and increased power Doppler signal). Ultrasound response to chemotherapy was defined when myometrial lesions decreased in echogenicity, Doppler signal or size. When ultrasound response occurred, despite chemoresistance defined by hCG values, MTX treatment was continued.
MTX was continued in three out of seven chemoresistant patients because ultrasound suggested response to MTX. All three of these patients achieved a complete response, thus nearly halving the MTX-resistance rate.
Among patients who are candidates for second-line treatment on the basis of hCG, ultrasound may identify those in whom further MTX administration can induce a delayed complete response.
甲氨蝶呤（MTX）耐药性是基于人绒毛膜促性腺激素（hCG）曲线来定义的。本研究的目的是确定低危非转移性妊娠滋养细胞肿瘤（GTN）患者，尽管 hCG 平台期暂时存在，但通过继续 MTX 治疗可以达到缓解。
在开始化疗之前，24 例FIGO Ⅰ期 GTN 患者接受经阴道超声检查，以确定子宫肌层病变（回声增强区和增加的功率多普勒信号）。化疗后的超声反应定义为子宫肌层病变的回声、多普勒信号或大小减少。尽管 hCG 值定义为化疗耐药，但当超声提示对 MTX 有反应时，继续给予 MTX 治疗。
由于超声提示对 MTX 有反应，因此在 7 例化疗耐药患者中有 3 例继续使用 MTX。这 3 例患者均获得完全缓解，从而使 MTX 耐药率降低近一半。
在基于 hCG 选择二线治疗的患者中，超声可能可以识别出那些可以通过进一步给予 MTX 诱导延迟完全缓解的患者。
