Verhoef Lisanne, Baartz David, Morrison Shona, Sanday Karen, Garrett Andrea Janet
Department of Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands.
Department of Gynaecology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
Aust N Z J Obstet Gynaecol. 2017 Aug;57(4):458-463. doi: 10.1111/ajo.12622. Epub 2017 Mar 27.
Gestational trophoblastic neoplasia (GTN) is classified as a highly curable group of pregnancy-related malignancies; however, approximately 15% will be persistent and require chemotherapy. Up to 25% of these women will develop resistance and 2% will develop disease relapse after initial chemotherapy. Despite the need for further chemotherapy in these women, cure rates are high.
To evaluate the outcomes of women diagnosed with low-risk GTN, assessing the type of treatment, the number of chemotherapy cycles received, development of resistance or disease relapse, survival, and to assess the feasibility of changing to a new drug regimen.
From March 2012 until February 2015, a retrospective study was conducted and 38 cases with low-risk GTN were reviewed. The number of cycles, type of treatment received, duration of treatment, development of resistance and disease relapse, and adverse side effects were analysed.
The median duration of follow-up was 12 months. Disease-free survival was 100% and primary complete remission rates were achieved in 85.3% of patients who were treated with actinomycin D and 25% patients who were treated with methotrexate (MTX). A change in chemotherapy was required for nine patients. One patient developed disease relapse. Nausea, fatigue and constipation were the most frequent adverse events reported with actinomycin D. All women were cured of their disease.
All women were successfully treated and achieved complete remission. Changing from MTX to actinomycin D as first-line chemotherapy for women with low-risk GTN was feasible and safe.
妊娠滋养细胞肿瘤（GTN）被归类为一组治愈率很高的妊娠相关恶性肿瘤；然而，约15%的患者会出现持续性病变，需要化疗。这些患者中高达25%会产生耐药性，2%在初始化疗后会出现疾病复发。尽管这些患者需要进一步化疗，但治愈率很高。
评估诊断为低危GTN的女性患者的治疗结果，评估治疗类型、接受的化疗周期数、耐药性或疾病复发情况、生存率，并评估更换新药方案的可行性。
2012年3月至2015年2月，进行了一项回顾性研究，对38例低危GTN患者进行了评估。分析了化疗周期数、接受的治疗类型、治疗持续时间、耐药性和疾病复发情况以及不良反应。
中位随访时间为12个月。无病生存率为100%，接受放线菌素D治疗的患者中85.3%实现了初次完全缓解，接受甲氨蝶呤（MTX）治疗的患者中25%实现了初次完全缓解。9例患者需要更换化疗方案。1例患者出现疾病复发。恶心、疲劳和便秘是使用放线菌素D时报告的最常见不良事件。所有女性患者的疾病均得到治愈。
所有女性患者均成功接受治疗并实现完全缓解。对于低危GTN女性患者，将一线化疗方案从MTX更换为放线菌素D是可行且安全的。
