Goldstein Donald P, Berkowitz Ross S, Horowitz Neil S
a 1 The New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA.
b 2 Brigham, and Women's Hospital, Division of Gynecologic Oncology, 75 Francis Street, Boston, MA 02115, USA.
Expert Rev Anticancer Ther. 2015;15(11):1293-304. doi: 10.1586/14737140.2015.1088786. Epub 2015 Oct 30.
Low-risk gestational trophoblastic neoplasia is a highly curable form of gestational trophoblastic neoplasia that arises largely from molar pregnancy and, on rare occasions, from other types of gestations. Risk is defined as the risk of developing drug resistance as determined by the WHO Prognostic Scoring System. All patients with non-metastatic disease and patients with risk scores <7 are considered to have low-risk disease. The sequential use of methotrexate and actinomycin D is associated with a complete remission rate of 80%. The most commonly utilized regimen for the treatment of patients resistant to single-agent chemotherapy is a multiagent regimen consisting of etoposide, methotrexate, actinomycin D, vincristine and cyclophosphamide. The measurement of human chorionic gonadotropin provides an accurate and reliable tumor marker for diagnosis, monitoring the effects of chemotherapy and follow-up to determine recurrence. Pregnancy is allowed after 12 months of normal serum tumor marker. Pregnancy outcomes are similar to those of normal population.
低危妊娠滋养细胞肿瘤是妊娠滋养细胞肿瘤的一种高度可治愈形式，主要源于葡萄胎妊娠，少数情况下源于其他类型的妊娠。风险是指根据世界卫生组织预后评分系统确定的发生耐药的风险。所有非转移性疾病患者和风险评分<7的患者被视为低危疾病。甲氨蝶呤和放线菌素D序贯使用的完全缓解率为80%。治疗对单药化疗耐药患者最常用的方案是由依托泊苷、甲氨蝶呤、放线菌素D、长春新碱和环磷酰胺组成的多药方案。人绒毛膜促性腺激素的测定为诊断、监测化疗效果和随访以确定复发提供了准确可靠的肿瘤标志物。血清肿瘤标志物正常12个月后允许妊娠。妊娠结局与正常人群相似。
