放线菌素D单日冲击疗法治疗低危妊娠滋养细胞肿瘤

范辰辰; 冯凤芝; 向阳; 万希润; 杨隽钧; 赵峻; 任彤

doi:10.3969/j.issn.1674-9081.2017.01.006

放线菌素D单日冲击疗法治疗低危妊娠滋养细胞肿瘤

Pulsed Actinomycin D for the Treatment of Low-risk Gestational Trophoblastic Neoplasia

摘要

摘要:
目的探讨放线菌素D(Actinomycin D，Act-D)单日冲击疗法用于低危妊娠滋养细胞肿瘤(low-risk gestational trophoblastic neoplasia, LRGTN)患者的疗效及安全性。
方法回顾性分析2012年1月至2015年10月北京协和医院95例接受Act-D单日冲击化疗方案治疗的LRGTN患者临床资料，对不同临床特征的疗效进行统计学分析，随诊血清人绒毛膜促性腺激素(β-human chorionic gonadotropin, β-hCG)水平评价治疗效果，并根据美国国家癌症研究所-不良事件通用术语标准评估化疗毒副反应的严重程度。
结果 95例患者中，79例经Act-D单日冲击疗法治疗后达到血清学完全缓解，完全缓解率83.2%(79/95)，总疗程平均(4.4±1.3)程(1~8程)，不同临床特征之间完全缓解率差异无统计学意义(P＞0.05)；16例患者因无效或耐药更改联合化疗方案后均达到血清学完全缓解。所有患者严重毒副反应发生率仅1.1%(1/95)。患者病情完全缓解后平均随诊(11.6±9.0)个月，3例复发，复发率3.8%。
结论 Act-D单日冲击化疗方案用于治疗LRGTN安全有效，且具备简便、耐受性好等优点，可作为LRGTN一线化疗方案。

Abstract:
Objective To investigate the efficacy and safety of pulsed Actinomycin D(Act-D) in the treatment of low-risk gestational trophoblastic neoplasia(LRGTN).
Methods Clinical data of 95 patients with LRGTN who were treated with pulsed Act-D biweekly in Peking Union Medical College Hospital from January 2012 to October 2015 were analyzed retrospectively.Efficacy in patients with different clinical features were analyzed with statistical analysis. Serum β-human chorionic gonadotropin(β-hCG) were measured in follow-up during chemotherapy to assess the efficacy. The severity of side effects was evaluated according to the United States National Cancer Institute-Common Terminology Criteria for Adverse Events (NCI-CTCAE).
Results Among the 95 patients, 79 (83.2%) achieved serum complete remission. Their chemotherapy courses ranged from 1 to 8 courses, with the mean of (4.4±1.3)courses. There was no statistically significant difference about the complete remission rate for the different clinical characteristics (P > 0.05). Sixteen patients changed regimen because of ineffectiveness or resistance, and achieved serum complete remission after combined chemotherapy. Severe side effects rate was 1.1 % (1/95). The mean duration of follow-up was (11.6±9.0) months. Three patients got recurrence, with the recurrence rate of 3.8%.
Conclusions Pulsed Act-D given biweekly was effective and well tolerated in patients with LRGTN. Because of its convenience, low cost, and good tolerance, it could be the choice of first-line chemotherapy for LRGTN.

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