Management and prognosis of patients with brain metastasis from gestational trophoblastic neoplasia: a 24-year experience in Peking union medical college hospital.
BACKGROUND
The optimal treatment for patients with brain metastasis from gestational trophoblastic neoplasia (GTN) has not been established. This study aims to investigate the clinical characteristics and the management of brain metastasis from GTN in relation to patients' outcomes.


METHODS
We retrospectively investigated 109 GTN patients with brain metastasis treated at Peking Union Medical College Hospital from January 1990 to December 2013. Patients mainly received multiagent chemotherapy with florouracil or floxuridine, dactinomycin, etoposide, and vincristine (FAEV) combined with intrathecal methotrexate with or without surgery.


RESULTS
In the 109 patients, sixty-two (56.1%) patients presented for primary therapy and 47 patients had failed chemotherapy elsewhere. Eight early demise patients who died before or during first cycle of chemotherapy were excluded from analysis. The median follow-up time was 47 months (range 9-180 months). The overall 5-year survival rate (OS) was 71.1%, while the OS rate for patients receiving primary chemotherapy in our hospital was 85.5%, and this fell to 51.9% in patients with failure multidrug chemotherapy elsewhere. Multivariate analysis demonstrated that International Federation of Gynecology and Obstetrics (FIGO) scores over 12 (Hazard ratio-HR 1.279, 95% CI 1.061-1.541, P = 0.010), failure of previous multidrug chemotherapy (HR 3.177, 95% CI 1.277-7.908, P = 0.013), and concurrent renal metastasis (HR 2.654, 95% CI 1.125-6.261, P = 0.026) were the risk factors of overall survival in patients with brain metastases from GTN.


CONCLUSIONS
Patients with brain metastasis from GTN have favorable outcome by multidrug chemotherapy and adjuvant therapies. Nevertheless, the prognosis is poor if the patients had previous multidrug failure chemotherapy history, concomitant with renal metastasis, or FIGO score over 12. Initial treatment with FAEV combined with intrathecal methotrexate chemotherapy can bring bright prospect to patients with brain metastases from GTN.
Departments of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, P. R. China. xcji1988@163.com.
Changji
C
Xiao
Departments of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, P. R. China. yangjunjun@gmail.com.
Junjun
J
Yang
Departments of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, P. R. China. youjian26@126.com.
Jing
J
Zhao
Departments of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, P. R. China. rentong89@163.com.
Tong
T
Ren
Departments of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, P. R. China. fengfz1969@sina.com.
Fengzhi
F
Feng
Departments of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, P. R. China. wanxr@pumch.cn.
Xirun
X
Wan
Departments of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, P. R. China. XiangY@pumch.cn.
Yang
Y
Xiang
D000328:Adult; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000556:secondary; D002681:China; D003131:Combined Modality Therapy; D003609:Dactinomycin / Q000008:administration & dosage; D018572:Disease-Free Survival; D019008:Drug Resistance, Neoplasm; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005467:Floxuridine / Q000008:administration & dosage; D031901:Gestational Trophoblastic Disease / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic; D011379:Prognosis; D012307:Risk Factors; D014750:Vincristine / Q000008:administration & dosage
D005467:Floxuridine; D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide