Gestational trophoblastic neoplasia with brain metastasis at initial presentation: a retrospective study
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To evaluate the survival and functional outcome of patients with brain metastasis due to gestational trophoblastic neoplasia (GTN).
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.
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.
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.
KeywordsChoriocarcinoma Gestational trophoblastic neoplasia Brain metastases Quality of life
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.
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