Roberts J P, Lurain J R
Department of Obstetrics and Gynecology, Northwestern University Medical Center, Chicago, Illinois, USA.
Am J Obstet Gynecol. 1996 Jun;174(6):1917-23; discussion 1923-4. doi: 10.1016/s0002-9378(96)70229-6.
Our purpose was to evaluate the efficacy and toxicity of single-agent chemotherapy and to identify risk factors associated with chemotherapy resistance in the treatment of low-risk metastatic gestational trophoblastic tumors.
We reviewed the records of all patients with gestational trophoblastic tumors treated with single-agent chemotherapy at the John I. Brewer Trophoblastic Disease Center of Northwestern University between 1962 and 1992. A total of 92 patients with low-risk metastatic gestational trophoblastic tumors by National Cancer Institute criteria were identified. Patients received methotrexate (n = 61), actinomycin D (n = 4), alternating methotrexate and actinomycin D (n = 5), or hysterectomy with methotrexate (n = 20) or actinomycin D (n = 2).
All 92 patients with low-risk metastatic gestational trophoblastic tumors were cured. Primary remission was achieved with initial single-agent therapy in 62 patients (67.4%). A second sequential single agent was used because of drug resistance in 20 patients (21.7%) or drug toxicity in 10 patients (10.9%). Only one patient (1%) needed multiagent chemotherapy to be cured. Adjuvant hysterectomy was performed in 22 patients (23.9%). Surgery was not required to remove resistant tumor foci. Chemotherapy toxicity, most commonly stomatitis, occurred in 36 patients (39.1%), but none of these effects was life threatening. Large vaginal metastasis was the only identifiable factor significantly associated with failure of initial single-agent chemotherapy (p = 0.03).
In this large series of patients with low-risk metastatic gestational trophoblastic tumors, sequential single-agent chemotherapy with methotrexate and actinomycin D provided safe and extremely effective treatment.
我们的目的是评估单药化疗的疗效和毒性，并确定低危转移性妊娠滋养细胞肿瘤治疗中与化疗耐药相关的危险因素。
我们回顾了1962年至1992年在西北大学约翰·I·布鲁尔滋养细胞疾病中心接受单药化疗的所有妊娠滋养细胞肿瘤患者的记录。根据美国国立癌症研究所标准，共确定了92例低危转移性妊娠滋养细胞肿瘤患者。患者接受甲氨蝶呤治疗（n = 61）、放线菌素D治疗（n = 4）、甲氨蝶呤与放线菌素D交替治疗（n = 5），或子宫切除术联合甲氨蝶呤（n = 20）或放线菌素D（n = 2）。
所有92例低危转移性妊娠滋养细胞肿瘤患者均治愈。62例患者（67.4%）通过初始单药治疗实现了初次缓解。20例患者（21.7%）因耐药或10例患者（10.9%）因药物毒性而使用了第二种序贯单药。仅1例患者（1%）需要联合化疗才能治愈。22例患者（23.9%）接受了辅助性子宫切除术。无需手术切除耐药肿瘤灶。化疗毒性最常见的是口腔炎，发生在36例患者（39.1%）中，但这些影响均无生命危险。巨大阴道转移是唯一与初始单药化疗失败显著相关的可识别因素（p = 0.03）。
在这一大型低危转移性妊娠滋养细胞肿瘤患者系列中，甲氨蝶呤和放线菌素D序贯单药化疗提供了安全且极其有效的治疗。
