Management of brain metastases in patients with high-risk gestational trophoblastic tumors

J Reprod Med. 2002 Jun;47(6):465-71.


Objective: To analyze the results of current treatment of patients with brain metastases from high-risk gestational trophoblastic tumors.

Study design: Consecutive patients treated between June 1981 and the end of 2000 with brain metastases from high-risk gestational trophoblastic tumors were selected from our computerized database.

Results: There were 39 patients with cerebral metastases from high-risk gestational trophoblastic tumors, and 30 (79.5%) of these patients are alive and in remission. Four patients died within 8 days of admission from disease extent. If these four patients are excluded, the survival of the remaining 35 patients is 86%. Eight patients had received prior chemotherapy, and 3 died of the disease. The antecedent pregnancy (AP) was term delivery in 23 (59%), and in 2 of those patients there was a prior history of a molar pregnancy in an AP. Six patients had a history of molar pregnancy as the AP, and in 10 the type of AP was uncertain. The presence of both liver and brain metastases was a particularly adverse prognostic combination, and only one of five patients is still alive in remission. No deaths or relapses occurred beyond 30+ months from the initiation of high-dose etoposide, methotrexate and actinomycin D with cyclophosphamide and vincristine chemotherapy.

Conclusion: With appropriate management, the outlook for patients with brain metastases from high-risk gestational trophoblastic tumors is good, and the majority of patients achieved sustained remission and probably a cure with chemotherapy as the dominant form of treatment. When the tumor is sufficiently chemosensitive, the blood-brain barrier does not prevent disease elimination.

MeSH terms

  • Adult
  • Antibiotics, Antineoplastic / administration & dosage
  • Antimetabolites, Antineoplastic / administration & dosage
  • Antineoplastic Agents, Phytogenic / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Brain Neoplasms / secondary*
  • Brain Neoplasms / therapy*
  • Cause of Death
  • Combined Modality Therapy
  • Cyclophosphamide / administration & dosage
  • Dactinomycin / administration & dosage
  • Etoposide / administration & dosage
  • Female
  • Gestational Trophoblastic Disease / pathology*
  • Humans
  • Methotrexate / administration & dosage
  • Pregnancy
  • Pregnancy Outcome
  • Pregnancy, High-Risk*
  • Prognosis
  • Remission Induction
  • Retrospective Studies
  • Risk Factors
  • Survival Analysis
  • Treatment Outcome
  • Vincristine / administration & dosage


  • Antibiotics, Antineoplastic
  • Antimetabolites, Antineoplastic
  • Antineoplastic Agents, Phytogenic
  • Dactinomycin
  • Vincristine
  • Etoposide
  • Cyclophosphamide
  • Methotrexate