EMP化疗方案在治疗妊娠滋养细胞肿瘤中的临床价值

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.

Clinical value of EMP chemotherapy program in the treatment of gestational tophoblastic neoplasia

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.