耐药和复发性滋养细胞肿瘤患者治疗方案探讨

Therapy for refractory and recurrent gestational trophoblastic tumor

目的探讨甲氨蝶呤(MTX)、MTX-CF方案、EMA/CO方案以及手术等综合治疗对于耐药和复发性恶性滋养细胞肿瘤的疗效。方法回顾性分析了17例耐药和复发的恶性滋养细胞肿瘤患者采用MTX、EMA/CO方案化疗及(或)辅以手术治疗后的临床疗效及不良反应。结果14例耐药患者及3例复发患者,共接受59个疗程化疗,最少的2个疗程,最多的6个疗程。14例获完全缓解,2例部分缓解,1例治疗无效死亡。主要不良反应为骨髓抑制及消化道反应。结论EMA/CO是治疗耐药和复发性滋养细胞肿瘤的有效方案。MTX或MTX-CF也是可选用的化疗方案。滋养细胞肿瘤的治疗措施虽然以化疗为主,但手术对控制出血和耐药复发患者仍具有十分重要的价值,而对普通患者也有缩短疗程,提高疗效等积极作用。

Objective To evaluate the response rate and toxicity of methotrexate, MTX-CF regimen, EMA/CO regimen and operation for women with refractory and recurrent gestational trophoblastic tumor. Methods 14 patients with refractory and 3 patients with recurrent gestational trophoblastic tumor were treated by methotrexate, MTX-CF regimen and EMA/CO regimen. Surgical excision as adjuncts to chemotherapy was performed in a selected subset of patients. The response and toxicity were assessed after treatment. Results 17 patients received totally 59 cycles of the chemotherapy with a range of 2-6 cycles for each patients. 14 patients achieved a complete remission while 2 patients had a partial remission and 1 showed nonresponse and died. The main complications were myelosuppression and gastrointestinal symptoms. Conclusion The EMA/CO regimen is an effective treatment for refractory and recurrent gestational trophoblastic tumor, and MTX or MTX-CF regimen is also effective for some selected cases. The effective results can be further improved when these chemotherapeutic schemes combined with surgery in the selected patients.