| Objectives:The aim of this study was to determine the outcomes and factors associated with failure in patients receiving actinomycin D as second-line chemotherapy for methotrexate-failed low-risk gestational trophoblastic neoplasia (GTN).Methods:Between June2000and June2009,53patients with methotrexate-failed low-risk GTN were treated with actinomycin D with or without surgery in Women’s Hospital, School of Medicine, Zhejiang University. Clinical response and survival as well as factors affect outcomes were analyzed retrospectively. T test and χ2analysis were used to analyze the relationship between covariates and treatment failure.Results:In53patients,40cases were MTX-resistant patients,13cases were who can not tolerate MTX toxicity.41(77.4%) patients receiving complete remission after ACTD chemotherapy,11(20.8%) patients in the two single-agent chemotherapy failure to accept EMA/CO chemotherapy receiving complete remission,1(1.9%) patient failed in the EMA/CO receiving complete remission after accepting EP EMA chemotherapy. All patients are not fatal toxicities, the main toxicities were bone marrow suppression, gastrointestinal tract, liver dysfunction, neurotoxicity, skin and mucosal ulceration. The factors significantly associated with resistance to secondary actinomycin D chemotherapy were Serum HCG level at the time of initiating actinomycin D chemotherapy and the reason why change the therapy.Conclusions:Low-risk gestational trophoblastic tumor after initial MTX regimen failed to consider ACTD chemotherapy as a secondary therapy.Serum hCG level at the time of initiating actinomycin D and the reason why change the therapy are important prognostic factors in patients with methotrexate-failed low-risk GTN receiving actinomycin D as second-line chemotherapy. |
