Gestational trophoblastic neoplasia with brain metastasis at initial presentation: a retrospective study

ObjectiveTo evaluate the survival and functional outcome of patients with brain metastasis due to gestational trophoblastic neoplasia (GTN).MethodsA 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.Results21 patients had GTN brain metastasis and were treated with multidrug chemotherapy without concomitant whole-brain radiation therapy. Three patients died early (<4weeks) of cerebral hemorrhage, 3 died1months after treatment initiation and 15 were alive at the date of last contact. The overall survival rate at 5years was 69.8% (95% CI 44.3-85.3). After excluding early deaths, the survival rate at 5years 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.ConclusionsAfter 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.