Ebeling K, Schönborn I, Johannsmeyer D
West-Klinik Dahlem, Berlin.
Zentralbl Gynakol. 1995;117(5):237-42.
The paper reports on clinical experiences of treatment of 58 patients with Gestational Trophoblastic Tumors (GTT), collected between 1978 and 1991. According to the Bagshawe-Score, 29 patients were at low-risk, 10 patients were assigned to the high-risk category. Among 29 metastatic cases, 5 patients had brain metastasis. In 33 patients, treatment started from the time of diagnosis. In 25 cases, treatment was initiated at other hospitals and patients were referred only after various unsatisfactory treatment measures. Low-risk patients were mainly subjected to methotrexate and folinic acid. Patients at medium-risk received a sequential chemotherapy. In high-risk patients we preferred the CHA-MOCA- or the EMA/CO-regimen. Treatment was successful in 91.4% of patients including all cases of low- and medium-risk. Five patients with brain metastases received systemic chemotherapy combined with intrathecal application of methotrexate and radiotherapy. Three of them could be cured. Patients taken from other hospitals more often underwent primary hysterectomies prior to systemic chemotherapy (40% versus 3%) and more often developed drug resistant tumors due to inadequate primary treatment. Five patients (8.6%) died from their disease, but only one of them received primary treatment in our department. Thus, the outcome (1/33 compared to 4/25) was significantly better for patients treated primarily at specialized centers.
该论文报告了1978年至1991年间收集的58例妊娠滋养细胞肿瘤（GTT）患者的临床治疗经验。根据Bagshawe评分，29例患者为低风险，10例患者被归为高风险类别。在29例转移病例中，5例有脑转移。33例患者从诊断时开始治疗。25例患者在其他医院开始治疗，在采取各种不理想的治疗措施后才转诊。低风险患者主要接受甲氨蝶呤和亚叶酸治疗。中风险患者接受序贯化疗。高风险患者我们更倾向于采用CHA-MOCA方案或EMA/CO方案。91.4%的患者治疗成功，包括所有低风险和中风险病例。5例脑转移患者接受全身化疗联合鞘内注射甲氨蝶呤和放疗。其中3例得以治愈。从其他医院转诊来的患者在全身化疗前更常接受原发性子宫切除术（40%对3%），并且由于初始治疗不足更常出现耐药肿瘤。5例患者（8.6%）死于该病，但其中只有1例在我们科室接受初始治疗。因此，主要在专科中心接受治疗的患者的治疗结果（1/33对比4/25）明显更好。
