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首页> 外文期刊>Gynecologic Oncology: An International Journal >Prevention of postmolar gestational trophoblastic neoplasia using prophylactic single bolus dose of actinomycin D in high-risk hydatidiform mole: a simple, effective, secure and low-cost approach without adverse effects on compliance to general follow-up or subsequent treatment.
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Prevention of postmolar gestational trophoblastic neoplasia using prophylactic single bolus dose of actinomycin D in high-risk hydatidiform mole: a simple, effective, secure and low-cost approach without adverse effects on compliance to general follow-up or subsequent treatment.

机译：在高危葡萄胎中使用预防性单次剂量的放线菌素D预防磨牙后妊娠滋养细胞肿瘤：一种简单，有效，安全且低成本的方法，对一般随访或后续治疗的依从性无不良影响。

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OBJECTIVE: To evaluate the efficacy of actinomycin D (Act-D) as prophylactic chemotherapy (P-Chem) to reduce postmolar gestational trophoblastic neoplasia (GTN) in patients with high-risk hydatidiform mole (Hr-HM). METHODS: From 1987 to 2006, 265 Hr-HM were selected in a retrospective analysis of a nonrandomized clinical trial of 1090 patients with gestational trophoblastic disease (GTD) followed up at a Trophoblastic Disease Center (TDC) in southern Brazil. From 1996 to 2006, 163 received a single bolus dose of Act-D at time of uterine evacuation (Hr-HM-chem group); 102 with the same risk factors did not get P-Chem (Hr-HM-control group). Variables were: number of patients with postmolar GTN who required chemotherapy during follow-up, postmolar GTN morbidity, compliance and operational costs. RESULTS: Postmolar GTN was diagnosed in 18.4% of the Hr-HM-chem patients (95% CI: 12.7-24.7) and in 34.3% of the Hr-HM-control patients (95% CI: 25.1-43.5). Postmolar GTN was 46% lower in P-Chem (RR=0.54; 95% CI: 0.35-0.82; NNT=7). P-Chem adverse effects were occasional and minor. When disease progressed to postmolar GTN, severity was the same, but costs were lower for the Hr-HM-chem group. Compliance with follow-up was high and similar in both groups. CONCLUSIONS: Follow-up of patients with Hr-HM showed that a single bolus dose of prophylactic Act-D reduced the incidence of postmolar GTN. Compliance and postmolar GTN morbidity were not affected. Treatment costs and emotional complications were reduced. This prophylactic approach can be adopted before uterine evacuation in any TDC that treats Hr-HM patients that present with undelivered moles.
机译：目的：评估放线菌素D（Act-D）作为预防性化疗（P-Chem）减少高风险葡萄胎（Hr-HM）患者的磨牙后妊娠滋养细胞赘生物（GTN）的疗效。方法：从1987年至2006年，在巴西南部的滋养细胞疾病中心（TDC）对1090例妊娠滋养细胞疾病（GTD）患者进行了一项非随机临床试验的回顾性分析中，选择了265 Hr-HM。从1996年到2006年，有163人在子宫排空时接受了单次推注剂量的Act-D（Hr-HM-chem组）。具有相同危险因素的102例未获得P-Chem治疗（Hr-HM对照组）。变量为：随访期间需要化疗的磨牙后GTN患者数量，磨牙后GTN发病率，依从性和手术费用。结果：Hr-HM-chem患者中有18.4％（95％CI：12.7-24.7）和Hr-HM-control患者中34.3％（95％CI：25.1-43.5）被诊断为磨牙后GTN。在P-Chem中，磨牙后GTN降低46％（RR = 0.54; 95％CI：0.35-0.82; NNT = 7）。 P-Chem的不良反应偶有和轻微。当疾病进展至磨牙后GTN时，严重程度相同，但Hr-HM-chem组的费用较低。两组的随访依从性很高，相似。结论：对Hr-HM患者的随访表明，单次推注剂量的预防性Act-D可以降低磨牙后GTN的发生率。顺应性和磨牙后GTN发病率不受影响。治疗费用和情绪并发症减少。可以在任何撤离痣的HTC患者中，在任何TDC进行子宫排空之前采用这种预防方法。

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