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Toshiyuki Kanno,Hideo Matsui,Yoshika Akizawa,Hirokazu Usui,Makio Shozu 대한부인종양학회 2018 Journal of Gynecologic Oncology Vol.29 No.6
Objective: Highly effective chemotherapy for patients with low-risk gestational trophoblastic neoplasia (GTN) is associated with almost a 100% cure rate. However, 20%–30% of patients treated with chemotherapy need to change their regimens due to severe adverse events (SAEs) or drug resistance. We examined the treatment outcomes of second-line chemotherapy for patients with low-risk GTN. Methods: Between 1980 and 2015, 281 patients with low-risk GTN were treated. Of these 281 patients, 178 patients were primarily treated with 5-day intramuscular methotrexate (MTX; n=114) or 5-day drip infusion etoposide (ETP; n=64). We examined the remission rates, the drug change rates, and the outcomes of second-line chemotherapy. Results: The primary remission rates and drug resistant rates of 5-day ETP were significantly higher (p<0.001) and significantly lower (p=0.002) than those of 5-day MTX, respectively. Forty-seven patients (26.4%) required a change in their chemotherapy regimen due to the SAEs (n=16) and drug resistance (n=31), respectively. Of these 47 patients failed the first-line regimen, 39 patients (39/47, 82.9%) were re-treated with single-agent chemotherapy, and 35 patients (35/39, 89.7%) achieved remission. Four patients failed second-line, single-agent chemotherapy and eight patients (17.0%) who failed first-line regimens were treated with combined or multi-agent chemotherapy and achieved remission. Conclusions: Patients with low-risk GTN were usually treated with single-agent chemotherapy, while 20%–30% patients had to change their chemotherapy regimen due to SAEs or drug resistance. The second-line regimens of single-agent chemotherapy were effective; however, there were several patients who needed multiple agents and combined chemotherapy to achieve remission.
Akira Mitsuhashi,Yuji Habu,Tatsuya Kobayashi,Yoshimasa Kawarai,Hiroshi Ishikawa,Hirokazu Usui,Makio Shozu 대한부인종양학회 2019 Journal of Gynecologic Oncology Vol.30 No.6
Objective: The present study investigated long-term outcomes of medroxyprogesteroneacetate (MPA) plus metformin therapy in terms of control of atypical endometrial hyperplasia(AEH) and endometrial cancer (EC), and post-treatment conception. Methods: We retrospectively analyzed 63 patients (42 with EC; 21 with AEH) who underwentfertility-sparing management using MPA plus metformin. MPA (400 mg/day) and metformin(750–2,250 mg/day) were administered to achieve complete response (CR). Metformin wasadministered until conception, even after MPA discontinuation. Results: Of the total patients, 48 (76%) had a body mass index (BMI) ≥25 kg/m2 and 43 (68%)showed insulin resistance. Sixty-one patients (97%) achieved CR within 18 months. CR ratesat 6, 8–9, and 12 months were 60%, 84%, and 90%, respectively. During a median followupperiod of 57 months (range, 13–115 months), relapse occurred in 8 of 61 patients (13.1%)who had achieved CR. Relapse-free survival (RFS) in all patients at 5 years was 84.8%. Uponunivariate analysis, patients with BMI ≥25 kg/m2 had significantly better prognoses than didthose with BMI <25 kg/m2 (odds ratio=0.19; 95% confidence interval=0.05–0.66; p=0.009). Overall pregnancy and live birth rates per patient were 61% (19/31) and 45% (14/31), respectively. Conclusions: MPA plus metformin is efficacious in terms of RFS and post treatmentconception. Moreover, metformin may be more efficacious for patients with BMI ≥25 kg/m2.