Gestational Choriocarcinoma with Brain Metastases : Treatment Results and Review of Literatures

Abstract

Fourteen patients diagnosed as gestational choriocarcinoma with brain metastases were reviewed concerning treatment results and prognostic factors. Most patients received combination chemotherapy concomitant with whole-brain irradia tion. Six of fourteen patients (42.8%) survived and were well without evidence of disease from 9 months to 18 years after the diagnosis of complete remission. Poor prognostic factors include time interval from antecedent pregnancy to start of treat ment more than 1 year (p < 0.05), modified WHO score more than 15 (p < 0.05), and craniotomy performed or not (p < 0.05). Furthermore, survivors are also af fected by neurological manifestations, failed prior chemotherapy and site of brain metastases but it is not of statistical significance. Management strategies of gesta tional choriocarcinoma patients at risk of developing brain metastases include ini tial administration of intensive combination chemotherapy in all high-risk patients and those with lung metastases to eradicate all the tumours. For those who have brain metastases, multimodality approaches including whole-brain irradiation, in tensive combination chemotherapy containing high dose methotrexate, and surgical removal in selected cases are recommended. Maintenance chemotherapy of at least 3 courses should be given after achieving remission to prevent recurrence. (Thai J Obstet Gynaecoly 1991;3:103-114.)