Brain metastatic GTN treated without radiotherapy: Case report

Choriocarcinoma is a rare, aggressive form of gestational trophoblastic neoplasia (GTN) that may metastasize to the brain in advanced stages. Brain involvement typically manifests as intracerebral hemorrhage and is associated with high morbidity and mortality. While whole brain radiotherapy (WBRT) remains a standard adjunct to chemotherapy, it carries significant long-term neurocognitive risks.

We report the case of a 28-year-old female who presented with neurological symptoms caused by a hemorrhagic brain metastasis from choriocarcinoma. Emergency craniotomy was performed to evacuate the hematoma and resect the tumor. Histopathology confirmed metastatic choriocarcinoma. The patient received systemic multi-agent chemotherapy using EMA-CO and EMA-EP regimens, without WBRT or intrathecal chemotherapy. Serum hCG levels normalized, and follow-up imaging showed no recurrence, indicating complete remission.

This case highlights the potential for complete remission in brain metastatic choriocarcinoma using a treatment strategy that combines emergency neurosurgical intervention and systemic chemotherapy alone. Avoiding WBRT may reduce long-term cognitive complications in selected patients. A multidisciplinary approach remains essential in the management of high-risk GTN.