title: Brain metastases in gestational trophoblast neoplasia: an update on incidence, management and outcome.
abstract: OBJECTIVE
  To update the demographic data, treatment details and outcomes for GTN patients with brain metastases managed with the modern treatment protocols at the UK centre for gestational trophoblast neoplasia at Charing Cross Hospital in London.
  
  
  METHODS
  The hospital database and pharmacy records were reviewed to identify GTN patients treated with brain metastases. Data was assembled on the specific GTN diagnosis, staging, prognostic scores, chemotherapy regimens, additional interventions and outcomes.
  
  
  RESULTS
  During the 22 year study period, 27 GTN patients with brain metastases were treated. One case clearly resulted from a prior molar pregnancy, 3 were of uncertain aetiology and 23 cases had no prior molar pregnancy. The standard chemotherapy regimens were EMA-CO or EMA-EP given with an enhanced CNS methotrexate dose combined with intrathecal methotrexate. Five patients required emergency neurosurgery and routine radiotherapy was not employed. Twenty three (85%) patients are long term survivors and four patients died. Of the patients who died, all four had chemotherapy refractive disease and two had extended intervals of 18 and 30 years from their antecedent pregnancy.
  
  
  CONCLUSIONS
  The incidence of brain metastases in postmolar pregnancy GTN is extremely low. Patients with non-molar choriocarcinoma have an approximate 20% risk of CNS disease and should have routine CNS imaging. Treatment with CNS doses of EMA-CO or EMA-EP appears curative for most patients.
authors.affiliation: Trophoblast Disease Service, Department of Medical Oncology, Charing Cross Hospital, Imperial Hospitals NHS Trust, London W6 8RF, UK. Electronic address: savage13561@msn.com.
authors.forename: Philip
authors.initials: P
authors.lastname: Savage
authors.affiliation: Trophoblast Disease Service, Department of Medical Oncology, Charing Cross Hospital, Imperial Hospitals NHS Trust, London W6 8RF, UK.
authors.forename: Inga
authors.initials: I
authors.lastname: Kelpanides
authors.affiliation: Trophoblast Disease Service, Department of Medical Oncology, Charing Cross Hospital, Imperial Hospitals NHS Trust, London W6 8RF, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Tuthill
authors.affiliation: Trophoblast Disease Service, Department of Medical Oncology, Charing Cross Hospital, Imperial Hospitals NHS Trust, London W6 8RF, UK.
authors.forename: Dee
authors.initials: D
authors.lastname: Short
authors.affiliation: Trophoblast Disease Service, Department of Medical Oncology, Charing Cross Hospital, Imperial Hospitals NHS Trust, London W6 8RF, UK.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Seckl
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000556:secondary*; D031954:Choriocarcinoma, Non-gestational / Q000473:pathology; D002945:Cisplatin / Q000008:administration & dosage; D015331:Cohort Studies; D003520:Cyclophosphamide / Q000008:administration & dosage; D003609:Dactinomycin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000188:drug therapy* / Q000473:pathology*; D006801:Humans; D006828:Hydatidiform Mole / Q000473:pathology; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D011247:Pregnancy; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D002945:Cisplatin; D008727:Methotrexate
keywords: Brain; Chemotherapy; Metastases; Trophoblast