放线菌素 D单药冲击量治疗低危妊娠滋养层瘤形成44例疗效分析

摘要

目的：探讨单药放线菌素D( Dactinomycin,ACTD)静脉冲击化疗用于治疗低危妊娠滋养层瘤形成( gestational trophoblastic neoplasia, GTN)的有效性及安全性。方法回顾性分析2012年1月至2013年12月本院收治的44例接受单药ACTD冲击化疗的低危GTN患者的临床资料,采用SPSS 12.0统计学分析软件分析临床资料的特征,随诊血清β绒毛膜促性腺激素水平评价治疗效果,根据WHO化疗药物毒性反应分度标准评估化疗不良反应严重程度。结果44例患者中,34例单药ACTD化疗有效,10例无效,总体有效率为78%(34/44)。对无效的患者改为多药联合化疗(氟尿嘧啶、长春新碱、ACTD、依托泊苷等)后最终均获得完全缓解。结论单药ACTD静脉冲击化疗用于低危GTN患者治疗的有效率高,不良反应轻微,用药安全、经济、方便,可以考虑作为低危GTN患者的一线治疗药物。%Objective To investigate the efficacy and toxicity of pulsed Dactinomycin given biweekly in the treatment of low-risk gestational trophoblastic neoplasia. Method Between 2012 and 2013, a total of 44 patients with low-risk GTT were treated with pulsed Dactinomycin in PUMCH. Datas of the patients clinical characteristics, courses of chemotherapy required to achieve complete remission, and toxicity related to chemotherapy were reviewed retrospec-tively and analyzed by SPSS 12. 0. Result 34 patients (78%) eventually attained complete remission by the treat-ment of pulsed Dactinomycin, the total course of chemotherapy in effective group was 3 to 9 courses with the median of 5 courses, and the duration of treatment was 28 to 114 days with the median of 56 days. 10 ineffective patients at-tained complete remission on combination chemotherapy ( FAEV, EMA/CO etc. ) after 2 to 4 courses of pulsed Dactinomycin with the median of 2 courses. No patients changed treatment because of side-effects of Dactinomycin. Conclusion Pulsed Dactinomycin given biweekly is effective and well tolerated for low-risk GTN, it is the choice of first-line treatment because of its safe, greater convenience and lower cost.