Treatment failure in malignant gestational trophoblastic disease

One hundred and thirty-three patients with malignant gestational trophoblastic disease (GTD) were admitted. All patients (86/86) of the nonmetastatic and metastatic low-risk groups and 89.4% (42/47) of the metastatic high-risk group showed remission. The overall remission rate was 96.2%. Among 5 patients with brain metastases, however, only one (20%) survived. We arrived at two main conclusions. First, brain metastatic lesions did not successfully respond to therapy utilizing conventional chemotherapeutic regimens. Second, the key factors for successful outcome in brain metastases were early diagnosis and aggressive initial therapy. Therefore, early detection of brain metastases should be made with: (1) fine computerized tomography (CT) or magnetic resonance imaging (MRI), (2) measurement of the ratio of serum to cerebrospinal fluid hCG concentration, and (3) early recognition of their clinical features.