GESTATIONAL TROPHOBLASTIC DISEASE METASTATIC TO THE BRAIN

PURPOSE: To evaluate clinical characteristics, treatment technique, an d results in patients with gestational trophoblastic disease metastati c to the brain. MATERIALS AND METHODS: From 1962 to 1994, 26 (4.1%) of 631 patients who underwent treatment for trophoblastic disease had or developed evidence of brain metastases (patients were aged 14-43 year s). All patients received multiagent systemic chemotherapy and whole-b rain irradiation. Total doses of radiation were 2,386-4,000 cGy (200-3 00 cGy per fraction). No patient received intrathecal chemotherapy. Pa tients were divided into three groups: group A, symptomatic brain meta stases at presentation; group B, asymptomatic or minimally symptomatic brain disease at presentation; and group C, development of brain meta stases during systemic chemotherapy. RESULTS: The overall 5-year actua rial survival rate was 51%. Multivariate analysis findings indicated t hat age, preceding pregnancy event human chorionic gonadotropin level, World Health Organization score, performance of craniotomy, and numbe r of brain metastases did not influence survival. The difference in th e 5-year overall survival rates between groups A (39%) and B (100%) wa s significant (P =.03). CONCLUSION: Gestational trophoblastic disease metastatic to the brain is curable with systemic chemotherapy and whol e-brain irradiation. The authors suggest treatment with steroids, chem otherapy (etoposide, high-dose methotrexate [1 g/m(2)], dactinomycin, cyclophosphamide, and vincristine sulfate), and concurrent whole-brain irradiation (3,000 cGy in 200-cGy fractions).