Management of brain metastases in patients with high-risk gestational trophoblastic tumors.

Abstract

OBJECTIVE:

To analyze the results of current treatment of patients with brain metastases from high-risk gestational trophoblastic tumors.

STUDY DESIGN:

Consecutive patients treated between June 1981 and the end of 2000 with brain metastases from high-risk gestational trophoblastic tumors were selected from our computerized database.

RESULTS:

There were 39 patients with cerebral metastases from high-risk gestational trophoblastic tumors, and 30 (79.5%) of these patients are alive and in remission. Four patients died within 8 days of admission from disease extent. If these four patients are excluded, the survival of the remaining 35 patients is 86%. Eight patients had received prior chemotherapy, and 3 died of the disease. The antecedent pregnancy (AP) was term delivery in 23 (59%), and in 2 of those patients there was a prior history of a molar pregnancy in an AP. Six patients had a history of molar pregnancy as the AP, and in 10 the type of AP was uncertain. The presence of both liver and brain metastases was a particularly adverse prognostic combination, and only one of five patients is still alive in remission. No deaths or relapses occurred beyond 30+ months from the initiation of high-dose etoposide, methotrexate and actinomycin D with cyclophosphamide and vincristine chemotherapy.

CONCLUSION:

With appropriate management, the outlook for patients with brain metastases from high-risk gestational trophoblastic tumors is good, and the majority of patients achieved sustained remission and probably a cure with chemotherapy as the dominant form of treatment. When the tumor is sufficiently chemosensitive, the blood-brain barrier does not prevent disease elimination.

• Authors: Edward S Newlands, Lydia Holden, Michael J Seckl, Iain McNeish, Sarah Strickland, Gordon J S Rustin
• Journal: The Journal of reproductive medicine (J Reprod Med) Vol. 47 Issue 6 Pg. 465-71 (Jun 2002) ISSN: 0024-7758 [Print] United States
• PMID: 12092015 (Publication Type: Journal Article)

Chemical References

• Antibiotics, Antineoplastic
• Antimetabolites, Antineoplastic
• Antineoplastic Agents, Phytogenic
• Dactinomycin
• Vincristine
• Etoposide
• Cyclophosphamide
• Methotrexate

Topics

• Adult
• Antibiotics, Antineoplastic (administration & dosage)
• Antimetabolites, Antineoplastic (administration & dosage)
• Antineoplastic Agents, Phytogenic (administration & dosage)
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Brain Neoplasms (secondary, therapy)
• Cause of Death
• Combined Modality Therapy
• Cyclophosphamide (administration & dosage)
• Dactinomycin (administration & dosage)
• Etoposide (administration & dosage)
• Female
• Gestational Trophoblastic Disease (pathology)
• Humans
• Methotrexate (administration & dosage)
• Pregnancy
• Pregnancy Outcome
• Pregnancy, High-Risk
• Prognosis
• Remission Induction
• Retrospective Studies
• Risk Factors
• Survival Analysis
• Treatment Outcome
• Vincristine (administration & dosage)