中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2012年
8期
571-576
,共6页
妊娠滋养细胞肿瘤%抗肿瘤联合化疗方案%博来霉素%依托泊甙%顺铂%治疗结果
妊娠滋養細胞腫瘤%抗腫瘤聯閤化療方案%博來黴素%依託泊甙%順鉑%治療結果
임신자양세포종류%항종류연합화료방안%박래매소%의탁박대%순박%치료결과
Gestational trophoblastic neoplasms%Antineoplastic combined chemotherapy protocols%Bleomycin%Etoposide%Cisplatin%Treatment outcome
目的 评价博来霉素+依托泊苷+顺铂(BEP)方案治疗高危型妊娠滋养细胞肿瘤(GTN)的疗效及安全性.方法 选择1997年1月-2011年10月在四川省肿瘤医院接受BEP方案化疗的GTN患者,按以下标准纳入本研究:(1)按2000年改良的国际妇产科联盟(FIGO)预后评分标准,预后评分≥7分者诊断为高危型GTN；(2)连续使用BEP方案≥2个疗程,结束全部化疗后随诊时间≥3个月.按此标准共42例患者纳入本研究,回顾性分析其临床资料.患者年龄20～49岁,平均30.2岁,所有患者均随访,随访截止至患者死亡或至2012年2月,随访时间为3个月～14年,观察其疗效、副反应及继发性肿瘤的发生情况.结果 (1)疗效:42例高危型GTN患者平均接受6.0个疗程(共251个疗程)的BEP方案化疗.其中,37例获得完全缓解,5例耐药,完全缓解率为88％( 37/42).37例完全缓解患者中,达到血清β-hCG水平正常的疗程数平均为3.5个(共129个),达到完全缓解的疗程数平均为6.1个(共227个).37例获完全缓解的患者中,31例接受单纯BEP方案化疗,单纯BEP方案化疗的完全缓解率为74％( 31/42)；4例在BEP方案化疗的基础上辅以手术治疗；2例在BEP方案化疗的基础上辅以放疗.5例耐药患者在平均接受4.8个疗程(共24个疗程)的BEP方案化疗后出现耐药,耐药后均改用依托泊苷+甲氨蝶呤+放线菌素D(EMA)/环磷酰胺+长春新碱(CO)方案化疗,2例同时辅以放疗、1例辅以手术治疗,最终4例获得完全缓解,1例死亡.(2)BEP方案化疗的副反应:BEP方案化疗后的主要副反应为骨髓抑制、消化道反应及脱发,其次是外周神经炎和肝功能损害,偶见轻微肺毒性反应.除1例年龄较大(49岁)的患者化疗后出现Ⅳ度骨髓抑制、原肺纤维化加重外,未发现严重过敏反应及明显心、肝、肺、肾功能损害患者.骨髓抑制主要是中性粒细胞减少,其发生率为66.5％( 167/251),多为Ⅰ～Ⅲ度,偶有Ⅳ度.(3)继发性肿瘤:41例存活患者随访期内均无继发性肿瘤发生.结论 对于年轻的高危型GTN患者BEP方案是一种安全、有效的化疗方案.
目的 評價博來黴素+依託泊苷+順鉑(BEP)方案治療高危型妊娠滋養細胞腫瘤(GTN)的療效及安全性.方法 選擇1997年1月-2011年10月在四川省腫瘤醫院接受BEP方案化療的GTN患者,按以下標準納入本研究:(1)按2000年改良的國際婦產科聯盟(FIGO)預後評分標準,預後評分≥7分者診斷為高危型GTN；(2)連續使用BEP方案≥2箇療程,結束全部化療後隨診時間≥3箇月.按此標準共42例患者納入本研究,迴顧性分析其臨床資料.患者年齡20～49歲,平均30.2歲,所有患者均隨訪,隨訪截止至患者死亡或至2012年2月,隨訪時間為3箇月～14年,觀察其療效、副反應及繼髮性腫瘤的髮生情況.結果 (1)療效:42例高危型GTN患者平均接受6.0箇療程(共251箇療程)的BEP方案化療.其中,37例穫得完全緩解,5例耐藥,完全緩解率為88％( 37/42).37例完全緩解患者中,達到血清β-hCG水平正常的療程數平均為3.5箇(共129箇),達到完全緩解的療程數平均為6.1箇(共227箇).37例穫完全緩解的患者中,31例接受單純BEP方案化療,單純BEP方案化療的完全緩解率為74％( 31/42)；4例在BEP方案化療的基礎上輔以手術治療；2例在BEP方案化療的基礎上輔以放療.5例耐藥患者在平均接受4.8箇療程(共24箇療程)的BEP方案化療後齣現耐藥,耐藥後均改用依託泊苷+甲氨蝶呤+放線菌素D(EMA)/環燐酰胺+長春新堿(CO)方案化療,2例同時輔以放療、1例輔以手術治療,最終4例穫得完全緩解,1例死亡.(2)BEP方案化療的副反應:BEP方案化療後的主要副反應為骨髓抑製、消化道反應及脫髮,其次是外週神經炎和肝功能損害,偶見輕微肺毒性反應.除1例年齡較大(49歲)的患者化療後齣現Ⅳ度骨髓抑製、原肺纖維化加重外,未髮現嚴重過敏反應及明顯心、肝、肺、腎功能損害患者.骨髓抑製主要是中性粒細胞減少,其髮生率為66.5％( 167/251),多為Ⅰ～Ⅲ度,偶有Ⅳ度.(3)繼髮性腫瘤:41例存活患者隨訪期內均無繼髮性腫瘤髮生.結論 對于年輕的高危型GTN患者BEP方案是一種安全、有效的化療方案.
목적 평개박래매소+의탁박감+순박(BEP)방안치료고위형임신자양세포종류(GTN)적료효급안전성.방법 선택1997년1월-2011년10월재사천성종류의원접수BEP방안화료적GTN환자,안이하표준납입본연구:(1)안2000년개량적국제부산과련맹(FIGO)예후평분표준,예후평분≥7분자진단위고위형GTN；(2)련속사용BEP방안≥2개료정,결속전부화료후수진시간≥3개월.안차표준공42례환자납입본연구,회고성분석기림상자료.환자년령20～49세,평균30.2세,소유환자균수방,수방절지지환자사망혹지2012년2월,수방시간위3개월～14년,관찰기료효、부반응급계발성종류적발생정황.결과 (1)료효:42례고위형GTN환자평균접수6.0개료정(공251개료정)적BEP방안화료.기중,37례획득완전완해,5례내약,완전완해솔위88％( 37/42).37례완전완해환자중,체도혈청β-hCG수평정상적료정수평균위3.5개(공129개),체도완전완해적료정수평균위6.1개(공227개).37례획완전완해적환자중,31례접수단순BEP방안화료,단순BEP방안화료적완전완해솔위74％( 31/42)；4례재BEP방안화료적기출상보이수술치료；2례재BEP방안화료적기출상보이방료.5례내약환자재평균접수4.8개료정(공24개료정)적BEP방안화료후출현내약,내약후균개용의탁박감+갑안접령+방선균소D(EMA)/배린선알+장춘신감(CO)방안화료,2례동시보이방료、1례보이수술치료,최종4례획득완전완해,1례사망.(2)BEP방안화료적부반응:BEP방안화료후적주요부반응위골수억제、소화도반응급탈발,기차시외주신경염화간공능손해,우견경미폐독성반응.제1례년령교대(49세)적환자화료후출현Ⅳ도골수억제、원폐섬유화가중외,미발현엄중과민반응급명현심、간、폐、신공능손해환자.골수억제주요시중성립세포감소,기발생솔위66.5％( 167/251),다위Ⅰ～Ⅲ도,우유Ⅳ도.(3)계발성종류:41례존활환자수방기내균무계발성종류발생.결론 대우년경적고위형GTN환자BEP방안시일충안전、유효적화료방안.
Objective To evaluate the effectiveness and safety of combination chemotherapy with bleomycin,etoposide and cisplatin (BEP) regimen on the patients with high-risk gestational trophoblastic neoplasia (GTN).Methods Forty-two patients with high-risk GTN admitted in Sichuan Cancer Hospital between Jan.1997 and Oct.2011 were analyzed retrospectively.The International Federation of Gynecology and Obstetrics (FIGO) prognostic score of all patients was more than 7.The mean age of patients was 30.2years (range 20 -49 years).All patients were treated with more than two cycles BEP regimen and followed up to the patients' death or at the end of Feb.2012.The clinical response,toxicity and the occurrence of secondary tumors were investigated.Results Forty-two high-risk GTN patients received the total of 251courses of the BEP regimen,the average number of courses for each patient was 6.0 courses.Thirty-seven patients achieved complete remission and 5 patients showed drug-resistant.The total complete remission rate of BEP regimen was 88％ ( 37/42 ).Among the complete remission patients,the total courses of BEP regimen of cases getting normal serum β-hCG level was 129 courses ( average 3.5 courses),and the total courses of cases achieving complete remission was 227 courses (average 6.1 courses ).Among the 37 complete remission patients,31 cases were treated with BEP regimen chemotherapy alone,4 patients with BEP regimen chemotherapy combined with surgical treatment (1 case had no cancer after surgery) and 2 cases with BEP regimen chemotherapy combined with radiation therapy.Therefore,the complete remission rate of BEP regimen chemotherapy alone was 74％ (31/42 ).There were 5 patients who showed drug-resistance after 24 courses of BEP regimen chemotherapy (average 4.8 courses),then received etoposide,methotrexate and dactinomycin( EMA )/cyclophosphamide and vincristine sulfate ( CO ) regimen chemotherapy after drugresistance,2 cases combined with radiation therapy,1 case combined with surgical treatment.Ultimately,4cases achieved complete remission,1 case died of cancer.The major toxicities of BEP regimen were included bone marrow suppression,digestive tract side effect and alopecic,followed by mild peripheral neuritis and abnormal liver function,rare cases of mild pulmonary toxicity.There were no severe anaphylaxis and obvious impairment of cardiac,liver,pulmonary and kidney function,except 1 patient (49 years old) had grade Ⅳbone marrow suppression and pulmonary fibrosis worsened after chemotherapy.The bone marrow suppression was mainly Ⅰ - Ⅲ degree neutropenia,and Incidence rate was 66.5％ ( 167/251 ).All the survival patients without secondary tumor.Conclusion For young high-risk GTN patients,BEP regimen chemotherapy may be safe and effective.
