Curative Effect Analysis Of Different Treatment Projects Of 168 Patients With Malignant Trophoblastic Tumor

【Objective 】Retrospective analysis 168 patients withmalignant trophoblastic tumor were treated with thedifferent chemotherapy project and( or) assist with thesurgical operation cure of clinical curative effect , to explorethe best treatment project and side effects prevention andcure method, in order to improve prognosis further .【Methods 】Retrospective analysis 168 patients withmalignant trophoblastic tumor admitted between 1997 to2002 in our hospital and University of Jilin the first hositalwere treated . All patients human chorionicgonadotropin( HCG) is all high in normal, and all throughgynecologic ultrasound, the chest slice or computertomographya check.Among 107 patients had invasive mole,61 patients had choriocarcinoma. 61 cases were comfirmedagain by post-operation histopathologic examination . Purechemotherapy 107 example . The chemotherapy adds thesurgical operation treatment total 61. Initial treatment casesgive three kinds of different chemotherapy project, (1)5Fuand KSM combination chemotherapy,(2)5Fu and AT1258combination chemotherapy,(3)5Fu and MTX combinationchemotherapy.Drug resistance patients give the PV projectchemotherapy. 5 patients because the uterine focus is existcarried on the arterial cannulatio chemotheray meanwhile inthe total body vein chemotherapy. 27 cases of totalhysterectomy, 7 cases of total uterus+ single( double)appendicis resection,23 of subtotal hysterectomy,4 of theuterus focus clearance. 3 cases of double ligation ofinternal iliac artery because of massive hematorrhea . Allpatients follow-up shortest 2 months, longest 6 years, May,median follow-up time was 28 months. Adopt theexamination of X2 carries on statistics processing.【Results】168 patients received 843 cycles of regimen.Thecure rate of invasion mole was 98.1%(105∕107)andchoriocarcinoma 93.4%(57/61). 98 patients were treatedby 5Fu and KSM combined chemotherapy,411 cycles ofregimen;38 patients were treated by 5Fu and AT1258combined chemotherapy,163 cycles of regimen;32 patientswere treated by 5Fu and MTX combined chemotherapy,139cycles of regimen. Three kinds of chemotherapy project curerate respectively is 85.7%(84∕98),84.2%(32∕38)和84.4%(27∕32), the difference did not show notable (P﹥0.05).24 cases appear to drug resistance, again throughaverage 5.4 course PV project chemotherapy and(or) thesurgical operation treatment,19 cases were cure(79.2%);3cases treatments utility(12.5%);2 cases died(8.3%).5 patientscarried on the arterial cannulatio chemotheray incombination with systemic intravenous infusionchemotherapy. 3 patients with drug resistance were treatedwith PV in combination with carried on drug resistanceinfocus the arterial cannulatio chemotheray ,another 2 patientsbecause of uterus focus keeps on the existence and requeststo reserve fertility capability in the fourth course carries onarterial cannulatio chemotheray ,the result all gets to cure,and reserved to fertility capability. 107 patients receivedsimple chemotherapy to reserve birth function , have alreadygot the gestation for 74 times, have already be born of 53child all grows normally. The main side effects forchemotherapy were myelosuppression and gastrointestinalsymptoms. Have 515 courses(61.1%) occurrence theleukopenia. 5Fu+KSM ,5Fu+AT1258 and 5Fu+ MTXleukopenia incidence rate is 63.0%(259∕411),61.3%(100∕163)和64.7%(90∕139),the difference did not shownotable. But 5Fu+MTX project leukopenia of Ⅲ,Ⅳdegree incidence rate notable more than other project, andleukopeniato keep on days also higher. 539course(63.9%)occurrence is nausea and vomiting ingastrointestinal symptoms. 5Fu+KSM,5Fu+AT1258 and5Fu+ MTX project nausea and vomiting incidence rate is65.7%(270∕411),58.9%(96∕163)和64.7%(90∕139). This total 61 patients carried on the surgicaloperation treatment, an age be partial to greatly, and did notbirth the request, complete remission rate is 95.2%(40/42) ,the average chemotherapy course counts is 3.9. Have 9cases who many course chemotherapy drug resistancebehind, carry on the surgical operation treatment because ofconsider the focus to limit, 7 cases cure(7/9,77.8%). Thiscase follow-up rate was 96.3%(156/162).Have 3 casesrelapse,the relapse rate of long-term follow-up was 96.3%(156/162),adding chemotherapy of ADM with the originalproject all and again, also 2 cases the excision of relapsefocus, all get to cure, follow-up up to now and all didrelapse again.【Conclusions】①5Fu and KSM,5Fu andAT1258,5Fu andMTX combination chemotherapy may be a protocol ofchoice in the treatment of malignant trophoblastic tumor. Bysimple chemotherapy, again the son and daughterthatgestation living behind growth are normally.②The PVregimen is an effective treatment for chemorefractorygestational trophoblastic tumour, have the curative effectgood,course short,side effects light and stay in the hospitaltime short etc. Still need the further clinical caseaccumulations, observe the long-term curative effect.③Selective arterial cannulatio chemotheray treatmentmalignant trophoblastic tumor with drug resistance focusis a safe valid method, particularly is to have the womenwho birth the request,can attain the purpose of reservethe uterine, for patien provide of new treatment means.④The main side effects for chemotherapy weremyelosuppression and gastrointestinal symptoms, withdosage of the chemotherapy medicine, combinationmedication to deny , give the medicine speed,course, patienindividual difference is related all and closely. 5Fu+MTXproject leukopenia of Ⅲ,Ⅳdegree incidence rate notablemore than other project, and leukopeniato keep on days alsohigher.⑤To elder did not request to bear with the uterusfocus drug resistance, should adopt the chemotherapyconsociation surgical operation treatment, can shorten tocure time, the risk that reduce to relapse.The surgicaloperation opportune moment of the choice reasonable, canreduce to bleed in the operation and the post-operationappears to metastasis focus,being advantageous to the risetreatment result.⑥Relapse still cure to chemotherapy as...