Gynecologic Oncology, Northside Hospital, Atlanta, GA, USA.
Int J Gynecol Cancer. 2013 Sep;23(7):1331-3. doi: 10.1097/IGC.0b013e3182a017fc.
Gestational trophoblastic disease usually follows a molar pregnancy but can occur also after an abortion or a term pregnancy. In only 10% of cases will treatment be required; and usually, single-agent chemotherapy will suffice. In high-risk disease, the multiagent regimen EMA-CO is usually used; and if that fails, most oncologists will use the EMA-EP regimen. If this does not produce a remission, there is no unanimity of opinion as to how to proceed. Numerous salvage regimens are in current use, and some centers do not consider high-dose chemotherapy.
A young woman presented 4 months after a normal spontaneous delivery with an elevated human chorionic gonadotropin level and multiple pulmonary metastases. She failed both the EMA-CO and EMA-EP regimens as well as additional standard chemotherapy. She was then treated with 4 separate courses of high-dose chemotherapy with autologous stem cell support, which produced a complete remission.
Even patients with high-risk gestational trophoblastic disease are usually cured with standard chemotherapy. Patients who fail such treatment should be considered for high-dose chemotherapy.
滋养细胞肿瘤通常发生于葡萄胎妊娠之后，但也可发生于流产或足月产之后。仅 10%的患者需要治疗，且通常单药化疗即可。在高危疾病中，EMA-CO 联合化疗方案通常被使用；如果该方案失败，大多数肿瘤医生会使用 EMA-EP 方案。如果该方案也无法缓解疾病，那么如何继续治疗就没有统一的意见。目前有许多挽救性化疗方案在使用，并且一些中心不考虑大剂量化疗。
一名年轻女性在正常足月分娩后 4 个月，出现人绒毛膜促性腺激素水平升高和多发肺转移。她先后接受了 EMA-CO、EMA-EP 方案以及其他标准化疗方案治疗，但均失败。随后，她接受了 4 个疗程的大剂量化疗联合自体造血干细胞支持治疗，获得完全缓解。
即使是高危滋养细胞肿瘤患者，通常也可通过标准化疗治愈。对于这些治疗失败的患者，应考虑使用大剂量化疗。
