Low-risk persistent gestational trophoblastic disease: Outcome after initial treatment with low-dose methotrexate and folinic acid from 1992 to 2000
Low-risk persistent gestational trophoblastic disease: Outcome after initial treatment with low-dose methotrexate and folinic acid from 1992 to 2000
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DOI：
10.1200/jco.2002.07.166
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发表时间：
2002-04-01
影响因子：
45.3
通讯作者：
Newlands, ES
中科院分区：
文献类型：
--
作者：
McNeish, IA;Strickland, S;Newlands, ES
目的：我们简化了妊娠滋养细胞疾病（GTD）的治疗，以减少暴露于潜在致癌化疗的患者数量。 Charing Cross 评分系统得分为 0 到 8 分的患者被归类为低风险，接受甲氨蝶呤 (MTX) 和亚叶酸 (FA)，而得分高于 8 的患者被归类为高风险，接受依托泊苷、甲氨蝶呤和放线菌素 (EMA)/环磷酰胺和长春新碱 (CO) 方案。 患者和方法：1992 年至 2000 年期间，485患有GTD的女性在英国伦敦查林十字医院开始接受MTX/FA治疗。如果患者出现 MTX 耐药性或毒性，则根据 β 人绒毛膜促性腺激素 (hCG) 水平改变治疗。如果血清hCG小于或等于100 IU/L，则患者接受更生霉素；如果 hCG 大于 100 IU/L，则患者接受 EMA/CO。结果：中位随访时间为 4.7 年。总生存率为 100%，复发率为 3.3%（485 名患者中的 16 名）。 485 名单独使用 MTX 的患者中，有 324 名 (66.8%) 的 hCG 值正常化，而 485 名患者中有 161 名 (33.2%) 需要改变治疗，其中 11 名是因为 MTX 毒性，150 名是因为 MTX 耐药。 67 例患者改为更生霉素，其中 58 例达到正常 hCG 值，9 例需要使用 EMA/CO 进行三线化疗。在 94 名从 MTX 直接改为 EMA/CO 的患者中，有 93 名 (98.9%) 的 hCG 值正常化。结论：单药更生霉素对于出现 MTX 耐药且 hCG 较低的低危 GTD 患者具有活性。将 GTD 的分层简化为两类（低风险和高风险）不会影响总体结果，并且可能会降低第二肿瘤的风险。
Purpose : We have simplified the treatment of gestational trophoblastic disease (GTD) in order to reduce the number of patients exposed to potentially carcinogenic chemotherapy. Patients who score 0 to 8 on the Charing Cross scoring system are classified as low-risk and receive methotrexate (MTX) and folinic acid (FA), whereas those who score higher than 8 are classified as high-risk and receive the etoposide, methotrexate, and dactinomycin (EMA)/cyclophosphamide and vincristine (CO) regimen.Patients and Methods: Between 1992 and 2000, 485 women with GTD were commenced on MTX/FA at Charing Cross Hospital, London, United Kingdom. If patients developed MTX resistance or toxicity, treatment was altered according to the level of beta human chorionic gonadotropin (hCG). If serum hCG was less than or equal to 100 IU/L, patients received dactinomycin; if hCG was greater than 100 IU/L, patients received EMA/CO.Results: The median duration of follow-up was 4.7 years. Overall survival was 100% and the relapse rate was 3.3% (16 of 485 patients). hCG values normalized in 324 (66.8%) of 485 patients with MTX alone, whereas 161 (33.2%) of 485 patients required a change in treatment, I I because of MTX toxicity and 150 because of MTX resistance. Sixty-seven patients changed to dactinomycin, of whom 58 achieved normal hCG values, and nine required third-line chemotherapy with EMA/CO. hCG values normalized in 93 (98.9%) of 94 patients who changed directly to EMA/CO from MTX.Conclusion: Single-agent dactinomycin has activity in patients with low-risk GTD who develop MTX resistance and whose hCG is low. Simplifying the stratification of GTD into two classes (low- and high-risk) does not compromise overall outcome and may reduce the risk of second tumors.