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目的探讨依托泊苷联合顺铂(EP)方案治疗高危、耐药及复发性妊娠滋养细胞肿瘤(GTN)的疗效及安全性。方法回顾性分析接受 EP 方案化疗的39例 GTN 患者的临床资料,其中初治高危患者25例,耐药患者9例,复发患者5例。39例患者中10例患者辅以手术治疗,所有患者均随访,观察其疗效及毒副反应,并追踪继发性肿瘤的发生情况和其中30例保留生育功能患者的生育情况。结果 39例 GTN 患者共接受了221个疗程的 EP 方案化疗,平均疗程数5.7个,总的完全缓解率为74%(29/39)。其中,25例初治高危患者总疗程数139个,平均疗程数5.6个,19例完全缓解,6例耐药,完全缓解率为76%(19/25);9例耐药患者化疗总疗程数55个,平均疗程数为6.1个,6例获完全缓解,3例再次耐药,完全缓解率为6/9;5例复发患者化疗总疗程数27个,平均疗程数为5.4个,4例完全缓解,1例耐药死亡,完全缓解率为4/5。该方案主要的毒副反应是骨髓抑制、消化道反应及脱发,骨髓抑制较轻,均为Ⅰ～Ⅲ度,未发生致死性毒副反应。30例保留生育功能患者共获妊娠8例次,其中人工流产2例次,足月妊娠分娩6例次,共获新生儿6个,均无先天性畸形发生,随访期内(随访时间最长者5年)小儿生长发育正常。所有存活患者无继发性肿瘤发生。结论 EP 方案作为一种安全、有效的化疗方案,可用于高危、耐药及复发性 GTN 患者的治疗。
Objective To investigate the efficacy and safety of etoposide combined with cisplatin (EP) in the treatment of high-risk, drug-resistant and recurrent gestational trophoblastic tumor (GTN). Methods The clinical data of 39 GTN patients undergoing EP regimen were retrospectively analyzed. Of them, 25 were newly diagnosed high-risk patients, 9 were resistant patients and 5 were relapsed. Ten patients in 39 patients were treated with surgery. All the patients were followed up to observe their curative effect and side effects. The incidence of secondary tumors and the fertility of 30 patients with reproductive function were observed. Results A total of 221 courses of EP regimen were received in 39 patients with GTN. The average course of treatment was 5.7 and the total complete remission rate was 74% (29/39). Among them, 25 cases of newly diagnosed high-risk patients with a total number of 139 courses, the average number of courses 5.6, 19 cases of complete remission, 6 cases of drug resistance, the complete remission rate was 76% (19/25); 9 cases of drug-resistant patients with the total course of chemotherapy The number of courses of chemotherapy was 6.1. Six cases were completely relieved and three cases were resistant again. The complete remission rate was 6/9. The total number of courses of chemotherapy in the five recurrence patients was 27, with an average of 5.4 courses and 4 cases Complete remission of cases, 1 case of drug-resistant death, the complete remission rate of 4/5. The main side effects of the program are myelosuppression, gastrointestinal reactions and hair loss, bone marrow suppression is mild, are Ⅰ ~ Ⅲ degrees, no lethal toxicity. 30 cases of patients with reproductive function were pregnant in 8 cases, of which 2 cases of induced abortion, full-term pregnancy delivery 6 cases, a total of 6 newborns, no congenital malformations, during the follow-up period (the longest follow-up period 5 years) children grow and develop normally. All surviving patients had no secondary tumor. Conclusion The EP regimen is a safe and effective chemotherapy regimen for the treatment of high-risk, drug-resistant and recurrent GTN patients.