Central nervous system involvement in gestational trophoblastic neoplasia.
BACKGROUND
To review the experience of seven cases of gestational trophoblastic neoplasia with central nervous system involvement.


METHODS
Seven patients among 50 cases of malignant gestational trophoblastic neoplasia were analyzed retrospectively in a single institution.


RESULTS
The mean age of the patients at diagnosis was 28.7 years (range: 20-34). While five of the patients presented initially with symptoms related to cranial involvement, the remaining two developed cerebral metastases during the therapy. In two patients, the presentation was so similar to a primary cranial pathology that craniotomy and biopsy revealed the trophoblastic involvement. The sites of involvement were the parietal lobe in three, temporal lobe in two and frontal lobe in two patients. Besides central nervous system involvement, four had additional 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 intrathecal methotrexate. Since one patient exhibited a fulminant clinical course, she could not be delivered a chemotherapy regimen and was lost in two months of initial diagnosis. The other patient was administered modified Bagshawe protocol (5 courses) which was switched to etoposide+methotrexate+actinomycin-D+vincristine+cyclophosphamide (6 courses) due to development of resistance. She was still alive and free of disease after 24 months 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 combination chemotherapy and radiotherapy. Measures should be focused on early diagnosis and prophylaxis.
Ayhan
A
A
Department of Obstetrics and Gynecology, Hacettepe University School of Medicine, Ankara, Turkey.
Tuncer
Z S
ZS
Tanir
M
M
Erbengi
A
A
D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001932:Brain Neoplasms / Q000556:secondary*; D002423:Cause of Death; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D007044:Hysterectomy; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000473:pathology* / Q000628:therapy; D011379:Prognosis; D011879:Radiotherapy Dosage; D018245:Trophoblastic Tumor, Placental Site / Q000473:pathology* / Q000628:therapy; D014594:Uterine Neoplasms / Q000473:pathology* / Q000628:therapy
D000970:Antineoplastic Agents