协和医学杂志

2017, v.8(01) 25-29

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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

范辰辰;冯凤芝;向阳;万希润;杨隽钧;赵峻;任彤;
FAN Chen-chen;FENG Feng-zhi;XIANG Yang;WAN Xi-run;YANG Jun-jun;ZHAO Jun;REN Tong;Department of Obstetrics and Gynecology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

摘要(Abstract):

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-h CG)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。
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 January2012 to October 2015 were analyzed retrospectively. Efficacy in patients with different clinical features were analyzed with statistical analysis. Serum β-human chorionic gonadotropin( β-h CG) 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 the95 patients,79( 83. 2%) achieved serum complete remission. Their chemotherapy courses ranged from 1 to 8courses,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.

关键词(KeyWords): 低危妊娠滋养细胞肿瘤;放线菌素D;化疗
low-risk gestational trophoblastic neoplasia;Actinomycin D;chemotherapy

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作者(Author): 范辰辰;冯凤芝;向阳;万希润;杨隽钧;赵峻;任彤;
FAN Chen-chen;FENG Feng-zhi;XIANG Yang;WAN Xi-run;YANG Jun-jun;ZHAO Jun;REN Tong;Department of Obstetrics and Gynecology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

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