Department of Gynaecologic Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India.
Department of Gynaecologic Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
Int J Gynecol Cancer. 2019 Mar;29(3):547-553. doi: 10.1136/ijgc-2018-000050. Epub 2019 Jan 29.
To assess the importance of salvage therapy in the management of high-risk gestational trophoblastic neoplasia (HR GTN) after failure of first line multiagent chemotherapy.
This retrospective study involving women with HR GTN treated at Kidwai cancer institute from 2000 to 2015. Initial chemotherapy consisted of etoposide, methotrexate with folinic acid, actinomycin D, cyclophosphamide and vincristine (EMA-CO). Thirty one patients who had incomplete response or relapsed were treated with various drug combinations employing etoposide and platinum agents. Adjuvant surgery and radiation were used in selected patients. Clinical response, survival and factors affecting outcomes were analysed.
Thirty one (37.8%) of the 82 patients developed resistance or relapsed after EMA-CO.Of these 25 (80.6%) had lasting complete response to salvage therapy. Salvage chemotherapy included, EMA EP alone in-15, EMA EP followed with BIP in-1, EMAEP followed with VAC in-2, EMA EP followed by TC and VAC in-1, EMA EP followed by TC in-6, TC followed by IA in-1 patient. Irradiation was given to 6 patients for brain metastasis, 1 for spine metastasis, 1 for pelvic tumor, and 1 for mediastinal mass. Operative procedures were hysterectomy in 9, conservative uterine tumour resection in 4 and excision of resistant lung lesion in one. Median follow up 25 (80.6%) patients was 2 years. Complete response to salvage therapy was seen in 25 (80.6%) patients. Overall survival after salvage therapy was 87.1% with median follow up of 2 years. Remission and survival was significantly influenced by βhCG level at the start of salvage therapy (p<0.001 and 0.006) but not with the stage or with WHO score.
Salvage therapy with platinum/etoposide based drug regimens in conjunction with surgery and radiation, was successful in achieving significant cure and survival in HR-GTN patients.
评估高危妊娠滋养细胞肿瘤（HR GTN）一线多药化疗失败后挽救治疗的重要性。
本回顾性研究纳入了 2000 年至 2015 年在 Kidwai 癌症研究所接受治疗的 HR GTN 女性患者。初始化疗包括依托泊苷、甲氨蝶呤+亚叶酸钙、放线菌素 D、环磷酰胺和长春新碱（EMA-CO）。31 例患者对 EMA-CO 反应不完全或复发，采用依托泊苷和铂类药物的各种药物组合进行治疗。在选择的患者中使用辅助手术和放疗。分析临床反应、生存和影响结果的因素。
82 例患者中，31 例（37.8%）在 EMA-CO 后出现耐药或复发。其中 25 例（80.6%）对挽救治疗有持久完全反应。挽救化疗包括：15 例单独 EMA EP、1 例 EMA EP 后加用 BIP、2 例 EMA EP 后加用 VAC、1 例 EMA EP 后加用 TC 和 VAC、6 例 EMA EP 后加用 TC、1 例 TC 后加用 IA。6 例患者因脑转移接受放疗，1 例因脊柱转移接受放疗，1 例因盆腔肿瘤接受放疗，1 例因纵隔肿块接受放疗。手术治疗包括子宫切除术 9 例，保守性子宫肿瘤切除术 4 例，耐药性肺病变切除术 1 例。中位随访 25 例（80.6%）患者 2 年。25 例（80.6%）患者挽救治疗后达到完全缓解。挽救治疗后总生存率为 87.1%，中位随访 2 年。缓解和生存与挽救治疗开始时βhCG 水平显著相关（p<0.001 和 0.006），但与分期或 WHO 评分无关。
联合手术和放疗的铂类/依托泊苷为基础的药物方案挽救治疗在 HR-GTN 患者中取得了显著的治愈和生存效果。
