Bower M, Newlands E S, Holden L, Short D, Brock C, Rustin G J, Begent R H, Bagshawe K D
Medical Oncology Unit, Charing Cross Hospital, London, United Kingdom.
J Clin Oncol. 1997 Jul;15(7):2636-43. doi: 10.1200/JCO.1997.15.7.2636.
To evaluate the results of etoposide, methotrexate, and dactinomycin alternating with cyclophosphamide and vincristine (EMA/CO) chemotherapy in women with high-risk gestational trophoblastic tumors (GTT) and to document the middle- and long-term toxicity of the regimen.
A total of 272 consecutive women with high-risk GTT, including 121 previously treated patients, were treated with weekly EMA/CO. The median follow-up duration is 4.5 years (range, 1 to 16).
The cumulative 5-year survival rate is 86.2% (95% confidence interval, 81.9% to 90.5%). No deaths from GTT have occurred later than 2 years after the end [corrected] of EMA/CO. In a multivariate model, adverse prognostic factors were the presence of liver metastases (P < .0001), interval from antecedent pregnancy (P < .0001), brain metastases (P = .0008), and term delivery of antecedent pregnancy (P = .045). There were 11 (4%) early deaths, while 213 patients (78%) achieved a complete remission. Forty-seven (17%) developed drug resistance to EMA/CO, of whom 33 (70%) were salvaged by further cisplatin-based chemotherapy and surgery. Two women developed acute myeloid leukemia, two cervical malignancy, and one gastric adenocarcinoma after EMA/CO. More than half (56%) of the women who had fertility-conserving surgery and who have been in remission at least 2 years have become pregnant since the completion of EMA/CO, with 112 live births, including three infants with congenital abnormalities.
EMA/CO is an effective and well-tolerated regimen for high-risk GTT. More than half of the women will retain their fertility; however, there is a small but significant risk of second malignancy.
评估依托泊苷、甲氨蝶呤和放线菌素D交替联合环磷酰胺及长春新碱（EMA/CO）化疗方案治疗高危妊娠滋养细胞肿瘤（GTT）的疗效，并记录该方案的中长期毒性。
共有272例连续的高危GTT女性患者，其中包括121例曾接受过治疗的患者，接受了每周一次的EMA/CO治疗。中位随访时间为4.5年（范围1至16年）。
5年累积生存率为86.2%（95%置信区间，81.9%至90.5%）。EMA/CO治疗结束[校正后]2年之后未发生因GTT导致的死亡。在多变量模型中，不良预后因素包括肝转移（P <.0001）、距前次妊娠的时间间隔（P <.0001）、脑转移（P =.0008）以及前次妊娠足月分娩（P =.045）。有11例（4%）早期死亡，而213例患者（78%）实现完全缓解。47例（17%）对EMA/CO产生耐药，其中33例（70%）通过进一步的顺铂化疗和手术挽救。两名女性在EMA/CO治疗后发生急性髓系白血病，两名发生宫颈恶性肿瘤，一名发生胃腺癌。在接受保留生育功能手术且缓解至少2年的女性中，超过一半（56%）自EMA/CO治疗结束后已怀孕，有112例活产，其中包括3例有先天性异常的婴儿。
EMA/CO是一种治疗高危GTT有效且耐受性良好的方案。超过一半的女性将保留生育能力；然而，存在较小但显著的发生第二原发性恶性肿瘤的风险。
