Wang Yuan'er (1932-1992) was a native of Jiangxi province. He graduated from Medical Treatment Department of Wuhan Medicine College in 1957. In 1967, he received his master degree from Capital University of Medical Sciences with a major in gynecological tumor. He had been working in Department of Gynecology of Peking Union Medical College Hospital since graduation. He was vice dean and professor of Department of Gynecology of Peking Union Medical College Hospital since graduation. Since early 1970s, under leadership of Prof. Song Hongzhao, he had been engaged in clinic research on Choriocarcinoma and malignant hydatidiform mole. He also made some research on gestational trophoblast disease, cytoplasmic inheritance, cure and immunization. He was awarded "Physician of the Year" by China Medicine Forum in 1988. He published more than 40 pieces of theses. He was also one of the writers of treatises: Diagnosis and Treatment of Choriocarcinoma and Gynecological Tumor.

CURATIVE TREATMENT OF CHORIOCARCINOMA

Song Hongzhao

(Department of OB/GYN, Peking Union Medical College Hospital)

Abstract

Choriocarcinoma is a highly malignant cancer of women. It is characterized by early and widespread metastasis. Once it is diagnosed, patients usually die within one year. For a long time, there was no satisfactory treatment.

Since 1949, a comprehensive study of this disease has been carried out. Through an effort of nearly 40 years, several chemotherapeutic agents were proved to be very effective for this disease. Up to the end of 1985, a total of 1400 cases were treated. The mortality rate has been reduced from more than 90% to less than 15%. All survivors were followed up periodically for more than 5 years. Repeated examinations with modern techniques revealed no sign of residual disease, indicating that they are cured. Among them about one sixth belonged to very late cases with generalized metastases all over the body, including brain, lungs, liver, spleen, kidneys, and intestine. All have returned to work. About one fifth of the patients who were young and desirous of child-birth were treated with chemotherapy alone without removal of uterus. 86.7%of them became pregnant after recovery with a total of 387 live births. All babies are growing up normally. Twenty married and 15 gave birth to normal third generation. Cytogenetic study of the peripheral lymphocytes of one third of the second generation and half of the third generation randomizedly selected revealed no deviation from normal in chromosomal number and aberrations. The eldest grand-children was now 8 years old. There was no increase of incidence of obstetric problem of mother and incidence of recurrence.

Besides, some other studies were also conducted. The outstanding achievements are as follows.

1. Through a review of 4385chest X-ray films taken for 1008 patients, the various forms of pulmonary metastatic shadows were studied and correlated with clinical symptoms and pathologic changes. In order to follow up the progression or regression of the various forms of metastatic shadows, serial films were taken at an interval of 10-14 days in a certain number of cases. When autopsy of deceased patients was permitted, postmortem pulmonary arteriogram was done on removed heart-lung specimens for the study of vascular changes of the metastatic lung lesions. As a result of this study, a comprehensive knowledge about the nature and development of the various forms of pulmonary metastatic shadows has been clarified.
2. Through a study of the clinical records of 119cases with definite evidences of brain metastasis and autopsy findings of 33deceased patients, it was found that before the appearance of the classical manifestations of brain metastasis. Frequently there occurs a set of neurological symptoms, which are transient in nature and easily neglected. This usually indicates the initiation of brain metastases. It is very useful for early diagnosis and treatment. The mortality rate, since then, has been reduced from 100% to 30%.
3. On the basis of an intensive study of the process of development of choriocarcinoma in a large series of cases, an anatomically based clinical staging system was proposed. Through long-term clinical use by many hospitals both in China and abroad, this clinical staging has proved to be simple, rational practical and in accordance with the clinical staging system of other cancer of women. Therefore, it has been adopted by the World Health Organization (WHO) and the International Federal Gynecology and Obstetrics (FIGO) as the universal international clinical staging system.
4. A nationwide retrospective survey for the incidence of hydatidiform mole in China was conducted by inquiring the pregnancy history of 3 million women from 26 provinces. Thus a population-based incidence of hydatidiform mole in china was first reported.
5. A case-control study was carried out in cooperation with the National Cancer Institute U.S.A. and a number of suspected risk factors were evaluated. This is useful for controlling the development of choriocarcinoma.
6. Some newly discovered sequences or complications of choriocarcinoma were described in detail through a study of large series of cases. This work adds more knowledge about clinical features of choriocarcinoma.