PDF(Pubmed)
Abstract：
Metastatic choriocarcinoma during viable pregnancy is rare worldwide, and neonate survival following pregnancy termination in the second trimester is uncommon. Here, we report the successful delivery of a pregnancy by a patient with metastatic choriocarcinoma, who received three courses of etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMA-CO) chemotherapy in the second trimester. After multidisciplinary discussions, she was administered paclitaxel and carboplatin (TC) chemotherapy. Regular contractions occurred during her first paclitaxel infusion, and a healthy infant was delivered by cesarean section at 26+4 gestational weeks. Choriocarcinoma was not detected in the placenta. Following delivery of the pregnancy, the patient underwent total treatment comprising one cycle of TC, seven cycles of EMA-CO, and five courses of etoposide, cisplatin, methotrexate, and dactinomycin chemotherapy; her serum level of beta-human chorionic gonadotropin gradually fell after chemotherapy. Uterine and pulmonary metastases shrank, and no distant metastasis or recurrence were found until the eighth course of maintenance treatment with immunotherapy. The patient received periodic chemotherapy for recurrence at the time of publishing this case report. The child was disease-free 15+ months after delivery. Despite serious metastases and complications, metastatic choriocarcinoma diagnosed in the second trimester of pregnancy can be successfully treated with minimal delay by multidisciplinary medical and nursing management.
摘要：
在可行的怀孕期间转移性绒毛膜癌在世界范围内很少见，在妊娠中期终止妊娠后的新生儿存活率并不常见。这里,我们报告了一名转移性绒毛膜癌患者成功分娩，他接受了三个疗程的依托泊苷，甲氨蝶呤,放线菌素D,环磷酰胺,和长春新碱（EMA-CO）化疗在孕中期。经过多学科的讨论，她接受了紫杉醇和卡铂(TC)化疗.在她第一次输注紫杉醇时发生了规律的收缩，健康婴儿在26+4孕周通过剖宫产分娩。在胎盘中未检测到绒毛膜癌。分娩后，患者接受了包括一个周期TC的全面治疗，EMA-CO的七个周期，和五个疗程的依托泊苷，顺铂,甲氨蝶呤,放线菌素化疗；化疗后患者血清β-人绒毛膜促性腺激素水平逐渐下降。子宫和肺转移缩小，直到第8个疗程的免疫疗法维持治疗，才发现远处转移或复发。在发表该病例报告时，患者因复发而接受定期化疗。该孩子在分娩后15个月以上无病。尽管有严重的转移和并发症，在妊娠中期诊断的转移性绒毛膜癌可以通过多学科医学和护理管理成功治疗，延迟最小。
