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.
Highlights
The optimal treatment for patients with brain metastasis from gestational trophoblastic neoplasia (GTN) has not been established
Patient characteristics A total of 109 GTN patients were identified as having brain metastasis at Peking Union Medical College Hospital (PUMCH) in the past 24 years, representing 3.4% of all patients treated with this cancer at our hospital during the same period
To the best of our knowledge, this study is the largest number of patients to explore the management, clinical outcomes and relevant risk factors associated with prognosis of GTN patients with brain metastasis
Summary
The optimal treatment for patients with brain metastasis from gestational trophoblastic neoplasia (GTN) has not been established. Gestational trophoblastic neoplasia (GTN) is used to refer to a group of uncommon malignant gynecological tumors arising from trophoblastic cells, including invasive mole, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor [1]. Owing to their remarkable sensitivity to chemotherapy, the cure rates are almost 100% in the low-risk group and nearly 90% in the high-risk group with current chemotherapy regimens [2,3]. Given the intellectual impairment by whole-brain radiation therapy over long term in patients, the study of new effective strategies with limited toxic effects have become an intense focus of clinical physicians
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