单日大剂量放线菌素D单药在低危妊娠滋养细胞肿瘤初次治疗中的疗效及安全性

Pulsed actinomycin D in Primary treatment of low-risk gestational trophoblastic neoplasia

目的探讨单日大剂量放线菌素D（AciD）单药在低危妊娠滋养细胞肿瘤初次治疗中的疗效及安全性。方法2009年至2012年我院收治并接受单日大剂量Act-D单药治疗的初治低危妊娠滋养细胞肿瘤病例23例，回顾性总结其临床资料、达完全缓解所需的化疗程数及化疗相关毒副反应。结果23例患者18例血清学完全缓解，完全缓解率为78．3％，不同临床特征之间完全缓解率无显著性差异。达完全缓解所需平均化疗程数（3．5±1．4）程（2～6程），平均巩固化疗程数（2．4±0．9）程（1～3程），总的平均化疗程数为（5．8±1．3）程（5～9程）。共计AcvD单药化疗120程，严重毒副反应（NCI-CTCAE3～5级）的发生率仅1．7％（2／120）。获完全缓解后平均随诊（6．2±3．3）月（2～13月），复发1例，复发率5．5％。结论单日大剂量Act-D单药方案安全有效，且同时具备简便、经济、耐受性良好的优点。

Objective： To investigate the efficacy and toxicity of pulsed actinomycin D given biweekly in treatment of low-risk gestational trophoblastic neoplasia. Methods： Twenty three patients with low-risk gestational trophoblastic neoplasia were primarily treated with pulsed actinomycin D biweekly in Peking Union Medical College Hospital. The data of the patients＇ clinical characteristics, courses of chemotherapy required to achieve complete remission, and toxicity related to chemotherapy were reviewed retrospectively. Results： Eighteen patients （18/23,78.3o//oo） achieved complete remission. Their serum 13-HCG levels declined to normal after （3.4 ±1.3） cycles of chemotherapy. The mean cycles of chemotherapy were （5.8±1.3）. The complete remission rate had no significant difference in the patients with different clinical characteristics. Serious side effects （NCI-CTCAE 3-5 grade） only appeared in 2 courses （2/120,1.7%）. All patients except one had no evidence of recurrent disease during follow up. The recurrent rate was 5.5 %. The mean duration of follow up was （6.2±3.3） months. Conclusions： Pulsed actinomycin D given biweekly may be effective and well tolerated for low-risk gestational trophoblastic neoplasia. It is the choice of treatment because of its greater convenience and lower cost.