Management and prognosis of patients with brain metastasis from gestational trophoblastic neoplasia: a 24-year experience in Peking union medical college hospital

Abstract

BackgroundThe optimal treatment for patients with brain metastasis from gestational trophoblastic neoplasia (GTN) has not been established. This study aims to investigate the clinical characteristics and the management of brain metastasis from GTN in relation to patients’ outcomes.MethodsWe retrospectively investigated 109 GTN patients with brain metastasis treated at Peking Union Medical College Hospital from January 1990 to December 2013. Patients mainly received multiagent chemotherapy with florouracil or floxuridine, dactinomycin, etoposide, and vincristine (FAEV) combined with intrathecal methotrexate with or without surgery.ResultsIn the 109 patients, sixty-two (56.1%) patients presented for primary therapy and 47 patients had failed chemotherapy elsewhere. Eight early demise patients who died before or during first cycle of chemotherapy were excluded from analysis. The median follow-up time was 47 months (range 9–180 months). The overall 5-year survival rate (OS) was 71.1%, while the OS rate for patients receiving primary chemotherapy in our hospital was 85.5%, and this fell to 51.9% in patients with failure multidrug chemotherapy elsewhere. Multivariate analysis demonstrated that International Federation of Gynecology and Obstetrics (FIGO) scores over 12 (Hazard ratio-HR 1.279, 95% CI 1.061-1.541, P = 0.010), failure of previous multidrug chemotherapy (HR 3.177, 95% CI 1.277-7.908, P = 0.013), and concurrent renal metastasis (HR 2.654, 95% CI 1.125-6.261, P = 0.026) were the risk factors of overall survival in patients with brain metastases from GTN.ConclusionsPatients with brain metastasis from GTN have favorable outcome by multidrug chemotherapy and adjuvant therapies. Nevertheless, the prognosis is poor if the patients had previous multidrug failure chemotherapy history, concomitant with renal metastasis, or FIGO score over 12. Initial treatment with FAEV combined with intrathecal methotrexate chemotherapy can bring bright prospect to patients with brain metastases from GTN.

Gestational Trophoblastic Disease: Clinical and Imaging Features

“…The reported prevalence of brain metastases in GTN ranges from 3.4% to 8.8% (52,53). The majority of cases (85%) occur in women with nonmolar choriocarcinoma, who have an approximate 20% risk of developing brain metastasis, emphasizing the importance of routine brain imaging in this group (54).…”

“…Brain Metastases.-Brain metastases from GTN may be single or multiple (52,53,55), are usually located at the gray-white matter junction of the cerebral hemispheres, and have a propensity to spontaneously hemorrhage (Fig 18). Such lesions show high attenuation at nonenhanced CT and variable signal intensity at MR imaging, depending on the chronicity of the intralesional hemorrhage.…”

Choriocarcinoma with brain, lung and vaginal metastases successfully treated without brain radiation or intrathecal chemotherapy: A case report

“…Mortality in patients with brain metastases is significant elevated, reported at 29.7% compared to an overall death rate from GTN of 5% (Xiao et al, 2015). Various modalities of multi-agent chemotherapy for high-risk patients have been described including MAC chemotherapy (methotrexate, actinomycin D and cyclophosphamide), CHAMOCA regimen (cyclophosphamide, hydroxyurea, actinomycin D, methotrexate, doxorubicin, melphalan and vincristine) and EMA-CO/EMACE (cyclophosphamide vs. cisplatin) chemotherapy.…”

Placental site trophoblastic disease

“… 4 The prevalence of brain metastases in gestational trophoblastic neoplasia. ranges from 3.4 % to 8.8 % , 5 6 but the incidence in placental-site trophoblastic tumor was not reported. A previous multi-center data showed that among 108 placental-site trophoblastic tumor cases, 7 only two patients had stage IV , with an incidence of brain metastasis less than 2 % .…”