Efficacy And Safety Of 5-Fluorouracil Combined With Actinomycin D In The Treatment Of Gestational Trophoblastic Neoplasia

Objective: Gestational Trophoblastic Neoplasia（GTN）usually occurs in women of childbearing age.Chemotherapy is the main treatment for GTN.The 5-fluorouracil + actinomycin D（5-Fu + Act-D）regimen has been used for many years in China and is generally used as a first-line treatment for some patients with low-or high-risk GTN.To analyze the efficacy and safety of this regimen in the treatment of GTN is aim to accumulate experience for clinical treatment.Methods:From January 2006 to January 2019,88 patients with invasive hydatidiform mole（58 cases）and choriocarcinoma（30 cases）were treated with 5-Fu + Act-D regimen chemotherapy in the Department of Gynecology of the Second Hospital of Hebei Medical University.According to FIGO 2000 prognostic system and anatomical staging standard,68 cases were low risk and 20 cases were high risk.Patients who achieved complete or partial remission were considered effective,and the efficacy of the regimen and its related risk factors were analyzed.This study was designed to evaluate the incidence of myelosuppression,nausea,vomiting,diarrhea,oral mucositis and liver function injury during chemotherapy according to WHO acute and subacute toxicity grading criteria of antineoplastic drugs.In this study,SPSS 17.0 was used for statistical analysis.The measurement data were expressed as mean and t-test was used.Enumeration data were calculated using χ^{2_</sup>Testing;Rank sum test was used for measurement data.P < 0.05 had statistical significance.Results:1.Efficacy: The remission rate of 5-Fu + Act-D regimen in GTN patients was 93.18%（82/88）;2.Relative factors of curative effect: The remission rate of invasive hydatidiform mole（98.28%,57/58）was significantly higher than that of choriocarcinoma（83.33%,25/30）,the difference was statistically significant（P 0.008）;however,there was no significant difference（P > 0.05）in clinical stage,prognosis score,tumor size,course of disease,blood hCG level before treatment,nature of previous pregnancy,number of pregnancies,etc.3.Toxic and side effects: A total of 438 courses of chemotherapy were given to all patients.The incidence of leukopenia was 42.92%（188/438）;the incidence of anemia was 35.16%（154/438）;the incidence of thrombocytopenia was 6.62%（29/438）;the incidence of nausea and vomiting was 52.74%（231/438）;the incidence of diarrhea was 16.67%（73/438）;the incidence of oral ulcer was 13.47%（59/438）;the incidence of liver function injury was 16.89%（74/438）;Conclusion:The remission rate of 5-Fu + Act-D regimen in the treatment of GTN is 93.18%,which can be used as the first-line chemotherapy regimen for GTN,as well as the salvage therapy for patients with low-risk GTN after failure of single agent chemotherapy.Choriocarcinoma is a risk factor of GTN.However,the number of cases in this study is small,and the above conclusions need further study.}