恶性滋养细胞肿瘤脑转移的疗效分析

Clinical analysis of intracranial metastases in gestational trophoblastic tumour

目的 评价恶性滋养细胞肿瘤脑转移患者的临床特性、预后影响因素、治疗方法及疗效。方法 回顾性分析了 1984年 12月至 1998年 12月我院收治的恶性滋养细胞肿瘤患者 814例中发生脑转移的 69例患者的临床资料。其中 ,绒毛膜癌 3 82例 ,发生脑转移者 61例 ( 16 0 % ) ;侵蚀性葡萄胎 4 3 2例 ,发生脑转移者 8例 ( 1 9% )。根据患者曾否接受化学治疗 (化疗 )及脑转移出现的时间 ,将所有脑转移患者分为 3组 ,即诊断脑转移后至本院治疗前未曾接受化疗者共 3 0例 (A组 ) ;诊断脑转移后至本院治疗前曾接受化疗者共 3 1例 (B组 ) ;在我院化疗期间出现脑转移者共 8例 (C组 )。除 12例入院时已濒临死亡 ,未及化疗或仅接受 1个疗程化疗即死亡外 ,其余 5 7例均接受了以 5 氟尿嘧啶为主的联合化疗或足叶乙甙、甲氨蝶呤、更生霉素 /环磷酰胺及长春新碱方案 (EMA/CO) 3～ 17个疗程 ,平均 8 2个疗程 ,同时辅以蛛网膜下腔穿刺鞘内注射甲氨蝶呤治疗。 69例中有 4例患者因颅内压急剧增高 ,濒临脑疝形成而急诊进行了开颅去骨瓣减压及转移瘤切除术。结果 除 12例患者未经正规化疗即死亡外 ,5 7例患者化疗后缓解率为 71 9% ( 4 1/ 5 7)。随诊该 5 7例患者的 5年累积生存率为4 5 8%。A、B、C 3组患者的缓解率分别为 80 0 %

Objective To evaluate characteristics of patients with intracranial metastases of gestational trophoblastic tumour (GTT) and determine the prognostic factors and therapeutic modality Methods We retrospectively reviewed the records of 814 GTT patients treated at Peking Union Medical College Hospital from 1984 to 1998 Of them, 382 were choriocarcinoma and 61 developed brain metastases (16 0%); 432 were invasive mole and 8 of them presented brain metastases (1 9%) Patients with brain metastases were divided into three categories: Group A, individuals with no prior chemotherapy (30 cases); Group B, patients who had received chemotherapy before transferred to our hospital (31 cases); Group C, individuals who developed brain metastases during therapy in our hospital ( 8 cases ) Apart from 12 patients died before or during the first cycle of chemotherapy, the remaining 57 patients were treated with 5 FU combined chemotherapy or etopside, methotrexate, kengshengmycin, /vincristine, cyclophosphamide (EMA/CO) regimen, the number of courses varied from 3 to 17 cycles The median number of chemotherapy for each patient was 8 2 Intrathecal methotrexate chemotherapy was utilized for all patients Emergency surgical decompression was performed in 4 cases who had symtomps of highly increased intracranial pressure Results Apart from 12 patients died before they received regular therapy in our hospital, remission rate of other 57 patients was 71 9% The cumulative survival rate for these 57 patients at 5 years was 45 8% Women with no prior chemotherapy (group A) had outcomes significantly better than those who had been treated before transfer to our hospital (group B) and there were no survivors among the patients who developed brain metastases during active chemotherapy (group C) [ P <0 05 (A Vs B); P <0 01 (A or B Vs C)] Conclusions Multiagent systemic chemotherapy combined with intrathecal methotrexate chemotherapy still play the key role in the management of brain metastatic GTT patients; Surgical decompression should be performed if significant neurologic symtoms are present