[Clinical analysis of intracranial metastases in gestational trophoblastic tumour]
1Department of Obstetrics and Genecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Objective:
To evaluate characteristics of patients with intracranial metastases of gestational trophoblastic tumour (GTT) and determine the prognostic factors and therapeutic modality.
Methods:
We retrospectively reviewed the records of 814 GTT patients treated at Peking Union Medical College Hospital from 1984 to 1998. Of them, 382 were choriocarcinoma and 61 developed brain metastases (16.0%); 432 were invasive mole and 8 of them presented brain metastases (1.9%). Patients with brain metastases were divided into three categories: Group A, individuals with no prior chemotherapy (30 cases); Group B, patients who had received chemotherapy before transferred to our hospital (31 cases); Group C, individuals who developed brain metastases during therapy in our hospital (8 cases). Apart from 12 patients died before or during the first cycle of chemotherapy, the remaining 57 patients were treated with 5-FU combined chemotherapy or etopside, methotrexate, kengshengmycin, /vincristine, cyclophosphamide (EMA/CO) regimen, the number of courses varied from 3 to 17 cycles. The median number of chemotherapy for each patient was 8.2. Intrathecal methotrexate chemotherapy was utilized for all patients. Emergency surgical decompression was performed in 4 cases who had symptoms of highly increased intracranial pressure.
Results:
Apart from 12 patients died before they received regular therapy in our hospital, remission rate of other 57 patients was 71.9%. The cumulative survival rate for these 57 patients at 5 years was 45.8%. Women with no prior chemotherapy (group A) had outcomes significantly better than those who had been treated before transfer to our hospital (group B) and there were no survivors among the patients who developed brain metastases during active chemotherapy (group C) [P < 0.05 (A Vs B); P < 0.01 (A or B Vs C)].
Conclusions:
Multiagent systemic chemotherapy combined with intrathecal methotrexate chemotherapy still play the key role in the management of brain metastatic GTT patients; Surgical decompression should be performed if significant neurologic symptoms are present.