Advertisement

International Journal of Clinical Oncology

, Volume 24, Issue 2, pp 153–160 | Cite as

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

  • Déborah Gavanier
  • Hélène Leport
  • Jérome Massardier
  • Fatima Abbas
  • Anne-Marie Schott
  • Touria Hajri
  • François GolfierEmail author
  • Pierre-Adrien Bolze
Original Article
  • 68 Downloads

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.

Keywords

Choriocarcinoma Gestational trophoblastic neoplasia Brain metastases Quality of life 

Notes

Funding

The authors acknowledge the French Ligue Nationale contre le Cancer and the Institut National du Cancer (INCa), which have recognized the French Centre for Trophoblastic Diseases as a Rare Tumour Centre since 2009 and which renewed funding that enabled this study; the French Centre for Trophoblastic Diseases thanks all the patients who, by giving their signed consent, allowed for this study to be carried out and all the physicians who declared patients because such nationwide epidemiologic studies directly depend on their constructive collaboration.

Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest.

References

  1. 1.
    Piura E, Piura B (2014) Brain metastases from gestational trophoblastic neoplasia: review of pertinent literature. Eur J Gynaecol Oncol 35:359–367Google Scholar
  2. 2.
    Lurain JR (2010) Gestational trophoblastic disease I: epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease, and management of hydatidiform mole. Am J Obstet Gynecol 203:531–539.  https://doi.org/10.1016/j.ajog.2010.06.073 CrossRefGoogle Scholar
  3. 3.
    Savage P, Kelpanides I, Tuthill M et al (2015) Brain metastases in gestational trophoblast neoplasia: an update on incidence, management and outcome. Gynecol Oncol 137:73–76.  https://doi.org/10.1016/j.ygyno.2015.01.530 CrossRefGoogle Scholar
  4. 4.
    Evans AC, Soper JT, Clarke-Pearson DL et al (1995) Gestational trophoblastic disease metastatic to the central nervous system. Gynecol Oncol 59:226–230CrossRefGoogle Scholar
  5. 5.
    Bolze P-A, Riedl C, Massardier J et al (2016) Mortality rate of gestational trophoblastic neoplasia with a FIGO score of ≥ 13. Am J Obstet Gynecol 214:390.e1–390.e8.  https://doi.org/10.1016/j.ajog.2015.09.083 CrossRefGoogle Scholar
  6. 6.
    Newlands ES, Holden L, Seckl MJ et al (2002) Management of brain metastases in patients with high-risk gestational trophoblastic tumors. J Reprod Med 47:465–471Google Scholar
  7. 7.
    Lurain JR (2011) Gestational trophoblastic disease II: classification and management of gestational trophoblastic neoplasia. Am J Obstet Gynecol 204:11–18.  https://doi.org/10.1016/j.ajog.2010.06.072 CrossRefGoogle Scholar
  8. 8.
    Ngan HYS, Seckl MJ, Berkowitz RS et al (2015) Update on the diagnosis and management of gestational trophoblastic disease. Int J Gynaecol Obstet 131 Suppl 2:S123–S126.  https://doi.org/10.1016/j.ijgo.2015.06.008
  9. 9.
    Maladies trophoblastiques gestationnelles, collection Recommandations et référentiels, ouvrage collectif édité par l’Inca, Boulogne-Billancourt, septembre 2010. http://www.e-cancer.fr/content/download/58366/532104/file/Plaquette_MTG-02-09-10.pdf
  10. 10.
    Alifrangis C, Agarwal R, Short D et al (2013) EMA/CO for high-risk gestational trophoblastic neoplasia: good outcomes with induction low-dose etoposide-cisplatin and genetic analysis. J Clin Oncol 31:280–286.  https://doi.org/10.1200/JCO.2012.43.1817 CrossRefGoogle Scholar
  11. 11.
    Xiao C, Yang J, Zhao J et al (2015) Management and prognosis of patients with brain metastasis from gestational trophoblastic neoplasia: a 24-year experience in Peking union medical college hospital. BMC Cancer 15:318.  https://doi.org/10.1186/s12885-015-1325-7 CrossRefGoogle Scholar
  12. 12.
    Bolze P-A, Attia J, Massardier J et al (2015) Formalised consensus of the European Organisation for Treatment of Trophoblastic Diseases on management of gestational trophoblastic diseases. Eur J Cancer 51:1725–1731.  https://doi.org/10.1016/j.ejca.2015.05.026 CrossRefGoogle Scholar
  13. 13.
    Seckl MJ, Sebire NJ, Berkowitz RS (2010) Gestational trophoblastic disease. Lancet 376:717–729CrossRefGoogle Scholar
  14. 14.
    Neubauer NL, Strohl AE, Schink JC, Lurain JR (2015) Fatal gestational trophoblastic neoplasia: An analysis of treatment failures at the Brewer Trophoblastic Disease Center from 1979 to 2012 compared to 1962–1978. Gynecol Oncol.  https://doi.org/10.1016/j.ygyno.2015.05.041 Google Scholar
  15. 15.
    Berkowitz RS, Goldstein DP, Bernstein MR (1984) Choriocarcinoma following term gestation. Gynecol Oncol 17:52–57CrossRefGoogle Scholar
  16. 16.
    Deng L, Zhang J, Wu T, Lawrie TA (2013) Combination chemotherapy for primary treatment of high-risk gestational trophoblastic tumour. Cochrane Database Syst Rev.  https://doi.org/10.1002/14651858.CD005196.pub4 Google Scholar
  17. 17.
    Rustin GJ, Newlands ES, Begent RH et al (1989) Weekly alternating etoposide, methotrexate, and actinomycin/vincristine and cyclophosphamide chemotherapy for the treatment of CNS metastases of choriocarcinoma. J Clin Oncol 7:900–903CrossRefGoogle Scholar
  18. 18.
    Small W, Lurain JR, Shetty RM et al (1996) Gestational trophoblastic disease metastatic to the brain. Radiology 200:277–280.  https://doi.org/10.1148/radiology.200.1.8657926 CrossRefGoogle Scholar
  19. 19.
    Neubauer NL, Latif N, Kalakota K et al (2012) Brain metastasis in gestational trophoblastic neoplasia: an update. J Reprod Med 57:288–292Google Scholar
  20. 20.
    Altintaş A, Vardar MA (2001) Central nervous system involvement in gestational trophoblastic neoplasia. Eur J Gynaecol Oncol 22:154–156Google Scholar
  21. 21.
    Tetef ML, Margolin KA, Doroshow JH et al (2000) Pharmacokinetics and toxicity of high-dose intravenous methotrexate in the treatment of leptomeningeal carcinomatosis. Cancer Chemother Pharmacol 46:19–26CrossRefGoogle Scholar
  22. 22.
    Howard SC, Jones DP, Pui C-H (2011) The tumor lysis syndrome. N Engl J Med 364:1844–1854.  https://doi.org/10.1056/NEJMra0904569 CrossRefGoogle Scholar
  23. 23.
    Schuman S, Pearson JM, Lucci JA, Twiggs LB (2010) Metastatic gestational trophoblastic neoplasia complicated by tumor lysis syndrome, heart failure, and thyrotoxicosis: a case report. J Reprod Med 55:441–444Google Scholar
  24. 24.
    Crawford RA, Newlands E, Rustin GJ et al (1997) Gestational trophoblastic disease with liver metastases: the Charing Cross experience. Br J Obstet Gynaecol 104:105–109CrossRefGoogle Scholar
  25. 25.
    Athanassiou A, Begent RH, Newlands ES et al (1983) Central nervous system metastases of choriocarcinoma. 23 years’ experience at Charing Cross Hospital. Cancer 52:1728–1735CrossRefGoogle Scholar

Copyright information

© Japan Society of Clinical Oncology 2018

Authors and Affiliations

  • Déborah Gavanier
    • 1
  • Hélène Leport
    • 1
  • Jérome Massardier
    • 2
    • 3
  • Fatima Abbas
    • 4
  • Anne-Marie Schott
    • 2
    • 4
  • Touria Hajri
    • 2
  • François Golfier
    • 1
    • 2
    Email author
  • Pierre-Adrien Bolze
    • 1
    • 2
  1. 1.Department of Gynecological Surgery and Oncology, Obstetrics, University of Lyon 1University Hospital Lyon SudPierre-BéniteFrance
  2. 2.French Centre for Trophoblastic DiseasesUniversity Hospital Lyon SudPierre-BéniteFrance
  3. 3.Department of Prenatal DiagnosisUniversity Hospital Femme Mere EnfantBronFrance
  4. 4.Pôle Information Médicale Evaluation Recherche, Equipe d’Accueil 4129Hospices Civils de LyonLyonFrance

Personalised recommendations