Gestational trophoblastic disease: does central nervous system chemoprophylaxis have a role?

In the UK there are standardized surveillance procedures for gestational tr ophoblastic disease. However, there are differences in practice between the two treatment centres in terms of definition of persistent gestational tro phoblastic disease, prognostic risk assessment and chemotherapeutic regimen s. The role of prophylactic chemotherapy for cerebral micrometastatic disea se in persistent gestational trophoblastic disease is unclear. We have anal ysed the outcome of 69 patients with lung metastases who elsewhere might ha ve received prophylactic intrathecal chemotherapy. Of the 69 patients, 67 r eceived intravenous chemotherapy only. The other two patients had cerebral metastases at presentation. One patient who received only intravenous chemo therapy subsequently developed a cerebral metastasis, but this patient's in itial treatment was compromised by non-compliance. This experience supports our current policy of not treating patients with pulmonary metastases, wit hout clinical evidence of central nervous system (CNS) involvement, with pr ophylactic intrathecal therapy.