Brain metastasis in gestational trophoblastic neoplasia: An update

Nikki L. Neubauer, Nawar Latif, Kapila Kalakota, Maryanne Marymont, William Small, Julian C. Schink, John R. Lurain

Research output: Contribution to journalArticle

24 Scopus citations

Abstract

OBJECTIVE: To update the treatment of brain metastases in gestational trophoblastic neoplasia (GTN) at the Brewer Trophoblastic Disease Center, comparing treatment and outcomes from 1995-2009 with those from 1962-1994. STUDY DESIGN: Thirtyseven patients with GTN who had brain metastases at presentation (25, 68%) or who developed brain metastases during treatment (12, 32%) were treated with chemotherapy and brain irradiation at the Brewer Center between 1962 and 2009 (26 prior to 1995 and 11 since 1995). Patients underwent whole brain irradiation (2400-4000 cGy in 200-300 cGy fractions prior to 1995, and 2400-3000 cGy in 200 cGy fractions since 1995) +/- radiosurgery. RESULTS: Of 11 patients with GTN treated for brain metastases since 1995, 7 (64%) are alive, and 4 died. Six (55%) of the 11 patients treated after 1995 were diagnosed with brain metastases during treatment, 3 (50%) of whom were cured, compared to 6 (23%) of the 26 patients treated before 1995, only 1 (17%) of whom was cured. CONCLUSION: The overall survival for all 37 patients with GTN who had brain metastases from 1962-2009 was 51% (19/37): 46% (12/26) before 1995 and 64% (7/11) after 1995. Survival was significantly influenced by symptoms at presentation: 100% (8/8) for asymptomatic patients versus 41% (7/17) for symptomatic patients (p = 0.0005). No patient who died had uncontrolled rain metastases. In our experience, therefore, brain metastases in GTN are curable with a combination of systemic multiagent chemotherapy and whole brain irradiation.

Original languageEnglish (US)
Pages (from-to)288-292
Number of pages5
JournalJournal of Reproductive Medicine for the Obstetrician and Gynecologist
Volume57
Issue number4
StatePublished - Aug 1 2012

Keywords

  • Brain metastases
  • Choriocarcinoma
  • Gestational trophoblastic neoplasia
  • Radiation

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

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    Neubauer, N. L., Latif, N., Kalakota, K., Marymont, M., Small, W., Schink, J. C., & Lurain, J. R. (2012). Brain metastasis in gestational trophoblastic neoplasia: An update. Journal of Reproductive Medicine for the Obstetrician and Gynecologist, 57(4), 288-292.