CENTRAL-NERVOUS-SYSTEM INVOLVEMENT IN GESTATIONAL TROPHOBLASTIC NEOPLASIA

Background. To review the experience of seven cases of gestational tro phoblastic neoplasia with central nervous system involvement. Methods. Seven patients among 50 cases of malignant gestational trophoblastic neoplasia were analyzed retrospectively in a single institution. Resul ts. The mean age of the patients at diagnosis was 28.7 years (range: 2 0-34). While five of the patients presented initially with symptoms re lated to cranial involvement, the remaining two developed cerebral met astases during the therapy. In two patients, the presentation was so s imilar to a primary cranial pathology that craniotomy and biopsy revea led the trophoblastic involvement. The sites of involvement were the p arietal lobe in three, temporal lobe in two and frontal lobe in two pa tients. Besides central nervous system involvement, four had additiona l lung and one had pelvic metastases. In terms of therapy, while five patients received methotrexate+actinomycin-D+cyclophosphamide regimen for 3 to 5 courses, only two could be administered additional intrathe cal methotrexate. Since one patient exhibited a fulminant clinical cou rse, she could not be delivered a chemotherapy regimen and was lost in two months of initial diagnosis. The other patient was administered m odified Bagshawe protocol (5 courses) which was switched to trexate+ac tinomycin-D+vincristine+cyclophosphamide (6 courses) due to developmen t of resistance. She was still alive and free of disease after 24 mont hs of initial diagnosis. Six of the patients were also delivered whole -brain irradiation simultaneously with chemotherapy. Conclusions. The prognosis of brain metastases still seems to be poor despite combinati on chemotherapy and radiotherapy. Measures should be focused on early diagnosis and prophylaxis.