EMP化疗方案在治疗妊娠滋养细胞肿瘤中的临床价值
Clinical value of EMP chemotherapy program in the treatment of gestational tophoblastic neoplasia
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摘要: 目的:探讨依托泊苷+甲氨蝶呤+铂类(EMP)化疗方案治疗妊娠滋养细胞肿瘤(GTN)的临床应用价值。方法:采用EMP方案化疗治疗GTN 22例,其中6例接受单纯EMP方案;16例采用EMP方案作为二线化疗,MTX单药作为初始化疗7例(31.8%),FAV方案作为初始化疗8例(36.4%),FAVE方案作为初始化疗4例(18.2%),EMA-CO方案作为初始化疗2例(9.1%),VMP方案作为初始化疗1例(4.5%)。1例在化疗基础上辅以手术治疗。结果:全部病人均达到血清学完全缓解,缓解率100%,其中单纯方案缓解率为37.5%;常见的不良反应依次为骨髓抑制、消化系统反应、脱发以及轻微肝肾毒性,差异有统计学意义(P<0.05)。1例化疗至第3疗程时出现Ⅳ度中性粒细胞减少,Ⅲ度血小板减少,予以集落刺激因子(G-CSF)及重组人白细胞介素-11治疗后缓解。随访22例,1例化疗疗程结束后2个月意外妊娠,人工流产后随访无异常,其余均正常。结论:EMP方案作为初始方案或是二线方案治疗GTN病人时疗效较满意,值得临床推广。Abstract: Objective: To discuss the clinical value of EMP(etoposide,methotrexate and platinum) chemotherapy in the treatment of gestational tophoblastic neoplasia(GTN). Methods: Twenty-two cases with GTN were treated with EMP program(including 6 cases treated with simple EMP program and EMP program as for second-line treatment in 16 cases).MTX as the initial chemotherapy in 7 cases(31.8%),FAV as the initial chemotherapy in 8 cases(18.2%),FAVE as the initial chemotherapy in 4 cases(18.2%),EMA-Co as the initial chemotherapy in 2 cases(9.1%) and VMP as the initial chemotherapy in 1 case(4.5%) were implemented.One cases were operated based on chemotherapy. Results: The serology index of all patients arrived at the complete alleviation,the alleviation rate of which was 100%(the simple program for 37.5%).The bone marrow suppression,digestive tract reaction,hair loss and slight hepatic and renal toxicity were the major adverse reactions,the difference of which was statistical significance(P<0.05).The IV degree neutropenia and Ⅲ degree thrombocytopenia in 1 case at three course of chemotherapy alleviated after the treatment with colony stimulating factor(CSF) and recombinant human interleukin-11.Twenty-two patients were followed up,the unintended pregnancy in 1 case after 2 months of chemotherapy was identified,who recovered normal after the abortion,and other cases were normal. Conclusions: The initial or second-line chemotherapy with EMP in the treatment of GTN is good effect,which is worthy of promotion.
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Key words:
- gestational trophoblastic neoplasia /
- etoposide /
- methotrexate /
- platinum
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