title: Brain metastasis in gestational trophoblastic neoplasia: an update.
abstract: OBJECTIVE
  To update the treatment of brain metastases in gestational trophoblastic neoplasia (GTN) at the Brewer Trophoblastic Disease Center, comparing treatment and outcomes from 1995-2009 with those from 1962-1994.
  
  
  METHODS
  Thirty-seven patients with GTN who had brain metastases at presentation (25, 68%) or who developed brain metastases during treatment (12, 32%) were treated with chemotherapy and brain irradiation at the Brewer Center between 1962 and 2009 (26 prior to 1995 and 11 since 1995). Patients underwent whole brain irradiation (2400-4000 cGy in 200-300 cGy fractions prior to 1995, and 2400-3000 cGy in 200 cGy fractions since 1995) +/- radiosurgery.
  
  
  RESULTS
  Of 11 patients with GTN treated for brain metastases since 1995, 7 (64%) are alive, and 4 died. Six (55%) of the 11 patients treated after 1995 were diagnosed with brain metastases during treatment, 3 (50%) of whom were cured, compared to 6 (23%) of the 26 patients treated before 1995, only 1 (17%) of whom was cured.
  
  
  CONCLUSIONS
  The overall survival for all 37 patients with GTN who had brain metastases from 1962-2009 was 51% (19/37): 46% (12/26) before 1995 and 64% (7/11) after 1995. Survival was significantly influenced by symptoms at presentation: 100% (8/8) for asymptomatic patients versus 41% (7/17) for symptomatic patients (p=0.0005). No patient who died had uncontrolled brain metastases. In our experience, therefore, brain metastases in GTN are curable with a combination of systemic multiagent chemotherapy and whole brain irradiation.
authors: Departments of Obstetrics and Gynecology and of Radiation Oncology, John I. Brewer Trophoblastic Disease Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors: Nikki L
authors: NL
authors: Neubauer
authors: Nawar
authors: N
authors: Latif
authors: Kapila
authors: K
authors: Kalakota
authors: MaryAnne
authors: M
authors: Marymont
authors: William
authors: W
authors: Small
authors: Julian C
authors: JC
authors: Schink
authors: John R
authors: JR
authors: Lurain
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000401:mortality* / Q000556:secondary / Q000628:therapy*; D019583:Dose Fractionation, Radiation; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000401:mortality* / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D006801:Humans; D011247:Pregnancy; D016634:Radiosurgery; D013238:Stereotaxic Techniques; D016019:Survival Analysis; D014594:Uterine Neoplasms / Q000473:pathology