Treatment for low-risk gestational trophoblastic disease: Comparison of single-agent methotrexate, dactinomycin and combination regimens
Treatment for low-risk gestational trophoblastic disease: Comparison of single-agent methotrexate, dactinomycin and combination regimens
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DOI：
10.1016/j.ygyno.2007.09.006
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发表时间：
2008-01-01
影响因子：
4.7
通讯作者：
Clagnan, Willian Simoes
中科院分区：
文献类型：
--
作者：
Abrao, Renato Antonio;de Andrade, Jurandyr Moreira;Clagnan, Willian Simoes
目标。根据FIGO分期系统，比较三种不同标准化疗方案对低危妊娠滋养细胞疾病的疗效。从1980年到2002年，我们回顾了108例低危持续性妊娠滋养细胞疾病患者，他们接受了一线化疗。根据化疗方案分为三组：甲氨蝶呤治疗组(MTX组，n=42)、放线菌素治疗组(ACT组，n=42)和甲氨蝶呤与放线菌素联合治疗组(MACT组，n=24)。我们比较了两组患者的化疗缓解疗程数、治疗持续时间、不良反应、治疗效果以及是否需要进行子宫切除术。甲氨蝶呤(MTX)、放线菌素(ACT)和联合方案(MACT)的完全缓解率分别为69%、61.4%和79.1%(P=0.7)。两组的疗程和化疗疗程数相似(p=0.2和p=0.4)。不良反应发生率MACT组62.5%，MTX组28.6%，ACT组19.1%(p=0.0003)。30例患者采用二线化疗。21例患者行全子宫切除术，组间比较差异无统计学意义(P=0.6)。我们的分析表明，对于低危妊娠滋养细胞疾病，单药化疗方案与联合化疗方案同样有效。放线菌素是一种毒性较小的药物，可能提供最具成本效益的治疗选择。由于甲氨蝶呤给药的可行性，必须考虑将其作为低资源地区的首选方案。(C)2007 Elsevier Inc.保留所有权利。
Objectives. To compare the efficacy of three different standard chemotherapy regimens for low-risk gestational trophoblastic disease according to the FIGO staging system in a single-institute setting.Methods. From 1980 until 2002, we retrospectively reviewed 108 cases with low-risk persistent gestational trophoblastic disease who were treated with first-line chemotherapy. Patients were divided in three groups according to chemotherapy regimen: patients treated with methotrexate (MTX group; n=42), patients treated with dactinomycin (ACT group; n=42) and patients treated with methotrexate and dactinomycin in combination (MACT group; n=24). We compared the number of chemotherapy courses for achieving remission, the duration of treatment, the adverse side effects, the efficacy of the treatment and the need for performing a hysterectomy among the groupsResults. The complete remission rates were 69%, 61.4% and 79.1% for methotrexate (MTX), dactinomycin (ACT) and the combination regimen (MACT) treated groups, respectively (p=0.7). The duration of the treatment and the number of chemotherapy courses were similar among the groups (p = 0.2 and p = 0.4, respectively). Adverse side effects rate was reported to be 62.5% in the MACT group, 28.6% in the MTX group and 19.1% in the ACT group (p=0.0003). Second-line chemotherapy was indicated for 30 patients. Hysterectomy was performed in 21 patients overall, and there was no difference among the groups (P=0.6).Conclusion. Our analysis indicates that single-agent chemotherapy regimens are as effective as combination chemotherapy for low-risk gestational trophoblastic disease. Dactinomycin is a less toxic drug and might offer the best cost-effective treatment option. Methotrexate must be considered as the regimen of choice for low resource areas because of the feasibility of its administration. (c) 2007 Elsevier Inc. All rights reserved.