Intracerebral choriocarcinoma

Nineteen patients with gestational trophoblastic disease (GTD) metastatic to the brain are reviewed. These patients constituted 9.0% of 210 [corrected] patients with GTD treated between November 1967 and December 1987. Four patients (21%) presented with primary neurological symptoms of GTD; four patients developed brain metastases during or after treatment with first drug(s) therapy; and 11 patients developed CNS metastases after resistance to initial chemotherapy. The initial chemotherapy in three of four patients who presented with brain metastases was with the combination of methotrexate, actinomycin D, and chlorambucil (MAC). Of the 15 patients who developed brain metastases after prior chemotherapy, 12 had received MAC at least once prior to the diagnosis of brain metastases, and in 5 patients, MAC was the first chemotherapy given after the diagnosis of brain metastases. All of the patients received whole-brain radiotherapy. Five of nineteen patients (26.3%) are living and well 4 to 15 years after the diagnosis of brain metastases. One of four patients (25%) who presented with brain metastases survived. These results suggest that MAC chemotherapy did not prevent the development of brain metastases in some of the patients and was less than optimal therapy in those whose brain tumor had become resistant to other cytotoxic agents.