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      저자 : Jiale Qin (검색결과 1 건)
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        The 16-year experience in treating low-risk gestational trophoblastic neoplasia patients with failed primary methotrexate chemotherapy

        Xiaodong Wu,Jiale Qin,Tao Shen,Weidong Fei,Lili Chen,Xing Xie,Weiguo Lu 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.4

        Objective: To assess the outcomes and toxic effects of 5-day actinomycin D (Act-D) salvagetherapy and to explore the predictors of Act-D resistance in patients with low-risk gestationaltrophoblastic neoplasia (GTN)who failed 5-day methotrexate (MTX) chemotherapy. Methods: This retrospective study analyzed patients with low-risk GTN administered Act-Dsalvage therapy after failing MTX chemotherapy at Women's Hospital, School of MedicineZhejiang University between January 2000 and December 2015. The clinical parameters ofthese patients were collected and analyzed. Results: The final analysis included 89 cases. Of these, 73 cases (82.02%) responded tosalvage Act-D. The remaining 16 resistant cases were switched to etoposide, MTX, Act-D/cyclophosphamide, and vincristine chemotherapy and achieved complete remission. Serumhuman chorionic gonadotrophin levels before Act-D salvage therapy (hCGAct-D)in the Act-D resistant cases were significantly higher than those in the Act-D responders (median 605 vs. 103 IU/L, p=0.009). However, the range of hCGAct-D values in Act-D responders was wider thanthat in Act-D-resistant cases (5.76–16,664 IU/L vs. 11.43–6,732 IU/L). Thus, assigning a generalcut-off value was difficult considering the individual setting. Except for 2 cases requiring othersalvage regimens due to Act-D toxicity, 97.80% of cases (89/91) tolerated the toxicity. During atleast 1-year follow-up, the survival rate was 100.00% and no case developed recurrence. Conclusion: Based on the good therapeutic effect and tolerable toxicity, we recommendAct-D salvage therapy for all patients with low-risk GTN who fail primary MTX chemotherapy. The higher serum hCG levels before Act-D salvage therapy may be associated with resistanceto this treatment.

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