title: Gestational trophoblastic disease metastatic to the brain.
abstract: OBJECTIVE
  To evaluate clinical characteristics, treatment technique, and results in patients with gestational trophoblastic disease metastatic to the brain.
  
  
  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 years). All patients received multiagent systemic chemotherapy and whole-brain irradiation. Total doses of radiation were 2,386-4,000 cGy (200-300 cGy per fraction). No patient received intrathecal chemotherapy. Patients were divided into three groups: group A, symptomatic brain metastases at presentation; group B, asymptomatic or minimally symptomatic brain disease at presentation; and group C, development of brain metastases during systemic chemotherapy.
  
  
  RESULTS
  The overall 5-year actuarial survival rate was 51%. Multivariate analysis findings indicated that age, preceding pregnancy event, human chorionic gonadotropin level, World Health Organization score, performance of craniotomy, and number of brain metastases did not influence survival. The difference in the 5-year overall survival rates between groups A (39%) and B (100%) was significant (P = .03).
  
  
  CONCLUSIONS
  Gestational trophoblastic disease metastatic to the brain is curable with systemic chemotherapy and whole-brain irradiation. The authors suggest treatment with steroids, chemotherapy (etoposide, high-dose methotrexate [1 g/m2], dactinomycin, cyclophosphamide, and vincristine sulfate), and concurrent whole-brain irradiation (3,000 cGy in 200-cGy fractions).
authors.affiliation: Division of Radiation Oncology, Robert H. Lurie Cancer Center, Chicago, IL 60611, USA.
authors.forename: W
authors.initials: W
authors.lastname: Small
authors.forename: J R
authors.initials: JR
authors.lastname: Lurain
authors.forename: R M
authors.initials: RM
authors.lastname: Shetty
authors.forename: C F
authors.initials: CF
authors.lastname: Huang
authors.forename: G L
authors.initials: GL
authors.lastname: Applegate
authors.forename: W N
authors.initials: WN
authors.lastname: Brand
mesh_terms: D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D011247:Pregnancy; D015996:Survival Rate; D014328:Trophoblastic Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary*; D014594:Uterine Neoplasms / Q000188:drug therapy / Q000473:pathology*