Fertility-preserving treatment in young patients with placental site trophoblastic tumors

摘要

Objective: To investigate the methods of fertility-sparing therapy for patients with placental site trophoblastic tumor (PSTT) and analyze the outcomes. Methods: From January 1999 to October 2010, the clinical features, pathology, diagnosis, fertility-preserving treatment, and outcomes of 6 patients with PSTT were studied retrospectively. Six patients were provided with multimodality treatment, which combined with surgery and chemotherapy. Five patients had received intrauterine arterial infusion chemotherapy. Three patients with polypoid-type tumor were treated by dilation and curettage and combination chemotherapy. Three patients with nodular masses underwent uterine tumor resection and combination chemotherapy. Two patients with nodular masses were treated by combination chemotherapy after dilation and curettage, and then uterine tumor resection was performed. Results: After follow-up for 10 to 104 months (mean, 47 months), 6 patients achieved a complete remission, presented no signs of recurrence, and had restored normal menstruation. One of them had a normal delivery in July 2011. Conclusions: Fertility-conserving therapy for young women with PSTT would be practicable if the patient is younger than 35 years, strongly desires to preserve fertility and responds well to chemotherapy and conservative surgery, the pathological results of which do not show poor prognostic factors and the gross pathologic type does not present markedly enlarged uterus, diffuse infiltrative and diffuse multifocal disease within the uterus.