Brain metastatic GTN treated without radiotherapy: Case report

Area of Science:

• Oncology
• Neurology
• Gynecology

Background:

• Choriocarcinoma, an aggressive gestational trophoblastic neoplasia (GTN), can metastasize to the brain, causing intracerebral hemorrhage.
• Brain metastases in GTN are associated with high morbidity and mortality.
• Whole brain radiotherapy (WBRT) is a standard treatment but carries significant long-term neurocognitive risks.

Observation:

• A 28-year-old female presented with neurological symptoms due to hemorrhagic brain metastasis from choriocarcinoma.
• Emergency craniotomy was performed for hematoma evacuation and tumor resection.
• Histopathology confirmed metastatic choriocarcinoma.

Findings:

• The patient achieved complete remission with systemic chemotherapy (EMA-CO and EMA-EP) without WBRT or intrathecal chemotherapy.
• Serum hCG levels normalized, and follow-up imaging showed no recurrence.
• Successful treatment was achieved through a combination of emergency neurosurgery and systemic chemotherapy.

Implications:

• This case demonstrates the potential for successful treatment of brain metastatic choriocarcinoma without WBRT.
• Avoiding WBRT may mitigate long-term cognitive complications in select patients.
• A multidisciplinary approach is crucial for managing high-risk GTN with brain metastases.