Treatment of high-risk gestational trophoblastic neoplasia and chemoresistance/relapsed disease
Treatment of high-risk gestational trophoblastic neoplasia and chemoresistance/relapsed disease
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DOI：
10.1016/j.bpobgyn.2021.01.005
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发表时间：
2021-07-13
影响因子：
5.5
通讯作者：
Berkowitz, Ross S.
中科院分区：
文献类型：
--
作者：
Braga, Antonio;Elias, Kevin M.;Berkowitz, Ross S.
高危妊娠滋养细胞肿瘤（GTN）对单药化疗产生耐药性的风险增加;因此，主要治疗应是以依托泊苷为基础的多药方案，最好是EMA/CO。缓解（人绒毛膜促性腺激素hCG正常化）后，至少需要三个EMA-CO巩固疗程以降低复发风险。在治疗期间，如果hCG水平在两周内连续两个值达到平台/增加，则诊断为化疗耐药性。当这种情况发生在缓解后，在没有新的怀孕，有复发。在这两种情况下，在重新评估疾病的程度后，EMA-EP是最常见的化疗选择。即使在这些情况下，缓解率也很高。缓解后，应每月测量hCG，持续一年。从缓解12个月后可以允许怀孕。在转诊中心对这些患者进行随访可以最大限度地减少这种疾病的死亡机会，应予以鼓励。(c)2021爱思唯尔出版
High-risk gestational trophoblastic neoplasia (GTN) has an increased risk of developing chemoresistance to single-agent chemotherapy; therefore, the primary treatment should be a multiagent etoposide-based regimen, preferably EMA/CO. After remission (normalization of human chorionic gonadotropin hCG), at least three consolidation courses of EMA-CO are needed to reduce the risk of relapse. Chemoresistance is diagnosed during treatment if hCG levels plateau/increase, in two consecutive values over a two-week period. When this occurs after remission, in the absence of a new pregnancy, there is a relapse. In both cases, after re-assessment of the extent of disease, EMA-EP is the most common chemotherapy choice. Even in these cases, remission rates are high. After remission is achieved, hCG should be measured monthly for a year. Pregnancy can be allowed after 12 months from remission. The follow-up of these patients in referral centers minimizes the chance of death from this disease and should be encouraged. (c) 2021 Published by Elsevier Ltd.