依托泊苷、甲氨蝶呤和放线菌素D治疗妊娠滋养细胞肿瘤
The management of gestational trophoblastic tumors with etoposide, methotrexate, and actinomycin D.
作者信息
Soto-Wright V, Goldstein D P, Bernstein M R, Berkowitz R S
机构信息
New England Trophoblastic Disease Center, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
出版信息
Gynecol Oncol. 1997 Jan;64(1):156-9. doi: 10.1006/gyno.1996.4534.
OBJECTIVE
To evaluate the efficacy and safety of etoposide, methotrexate, and actinomycin D (EMA) as primary and secondary therapy for gestational trophoblastic tumor (GTT).
METHODS
In a retrospective study, the medical records of all patients with middle-risk metastatic GTT or nonmetastatic choriocarcinoma receiving primary EMA and patients with GTT resistant to single-agent regimens treated with secondary EMA were reviewed. Hematologic toxicity was graded using WHO criteria.
RESULTS
Seven patients received primary EMA with 5 (67%) achieving remission. Twenty-two patients with resistance to single-agent regimens received secondary EMA with 21 (95%) achieving remission. The most acute hematologic toxicity was grade 1 or 2. Only 2 of 90 EMA cycles were associated with grade 4 toxicity requiring hospital admission.
CONCLUSION
Although EMA effectively induces remission with minimal acute hematologic toxicity in the primary and secondary therapy of GTT, recently published data regarding secondary tumors associated with etoposide exposure should restrict its use to patients who absolutely require etoposide to achieve remission.
目的
评估依托泊苷、甲氨蝶呤和放线菌素D（EMA）作为妊娠滋养细胞肿瘤（GTT）一线和二线治疗的疗效及安全性。
方法
在一项回顾性研究中，对所有接受一线EMA治疗的中危转移性GTT或非转移性绒毛膜癌患者以及接受二线EMA治疗的对单药方案耐药的GTT患者的病历进行了回顾。血液学毒性采用WHO标准分级。
结果
7例患者接受一线EMA治疗，5例（67%）获得缓解。22例对单药方案耐药的患者接受二线EMA治疗，21例（95%）获得缓解。最严重的急性血液学毒性为1级或2级。90个EMA疗程中仅有2个与需要住院治疗的4级毒性相关。
结论
尽管EMA在GTT的一线和二线治疗中能有效诱导缓解且急性血液学毒性最小，但最近发表的关于依托泊苷暴露相关继发性肿瘤的数据应将其使用限制于绝对需要依托泊苷才能实现缓解的患者。
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