Gestational trophoblastic neoplasia with brain metastasis at initial presentation: a retrospective study

Abstract

Objective

To evaluate the survival and functional outcome of patients with brain metastasis due to gestational trophoblastic neoplasia (GTN).

Methods

A 17-year retrospective study based on case review of women with brain metastasis from GTN identified by the electronic databases held in the French Reference Centre. Primary outcome measure: 5-year overall survival calculated with the Kaplan–Meier method. Secondary outcome measures: causes of death, prognostic factors and functional outcomes.

Results

21 patients had GTN brain metastasis and were treated with multidrug chemotherapy without concomitant whole-brain radiation therapy. Three patients died early (< 4 weeks) of cerebral hemorrhage, 3 died ≥ 1 months after treatment initiation and 15 were alive at the date of last contact. The overall survival rate at 5 years was 69.8% (95% CI 44.3–85.3). After excluding early deaths, the survival rate at 5 years was 81.5% (95% CI 52.3–93.7). No predictive factor of survival was identified. Although 11 of the 12 (92%) surviving patients contacted still reported sequelae, nine of them (75%) had resumed a normal life.

Conclusions

After excluding early deaths, this study implies a high survival rate in patients with brain metastasis from GTN. These results were achieved in the total absence of whole-brain radiotherapy and almost completely without the need for intrathecal methotrexate.

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