Management of gestational trophoblastic neoplasia with metastasis to the central nervous system: A 12-year review at the Philippine General Hospital.

OBJECTIVE

To evaluate the clinical characteristics, treatment modalities and outcomes of patients with intracranial metastases resulting from gestational trophoblastic neoplasia (GTN).

METHODS

A retrospective study was done of patients with brain metastases due to GTN admitted to the Trophoblastic Diseases Section, Department of Obstetrics and Gynecology, Philippine General Hospital, from January 1992 to December 2004. Systemic chemotherapy in the form of methotrexate, etoposide, actinomycin D, cyclophosphamide and vincristine was the treatment of choice. Concomitant whole brain irradiation at a dose of 2,000-3,000 cGy (in 10 fractions of 200-300 cGy) was also given.

RESULTS

During 1992-2004, 30 patients with stage IV GTN (brain metastases) were diagnosed based on history, physical examination and computed tomography of the brain at the Philippine General Hospital. Of the 30 patients, 17 (56.7%) belonged to the "early" group (having central nervous system [CNS] symptoms on presentation), while 13 (43.3%) were in the "late" group (individuals who developed lesions during chemotherapy or who had relapsed after initial complete or partial remission). Headache was the most common neurologic symptom. Thirteen received etoposide, methotrexate, actinomycin D with cisplatin and etoposide, 5 received EMACE, 6 received methotrexate actinomycin-D and cyclophosphamide and 1 received methotrexate, etoposide, actinomycin-D. Of the 30 patients, 14 (46.7%) received concurrent whole brain irradiation. Eight (27%) patients responded to treatment and were considered in remission; remission was achieved in 6 of 17 (35%) in the early group and 2 of 13 (15%) in the late group. The mean survival time for the early CNS group was 7.3 months; it was 8.3 months for the late CNS group.

CONCLUSIONS

Intracranial metastasis in GTN is a curable disease that carries compromised survival because of difficulty in implementing the treatment regimen, patient noncompliance and late diagnosis.