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Real-world data of 14 cases of brain metastases from gestational trophoblastic neoplasia and a literature review

  • Gynecologic Oncology
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Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

The aim of this study was to investigate the diagnosis, treatment, and prognosis of patients with brain metastases from gestational trophoblastic neoplasia (GTN) in the real world.

Methods

Analyzing the clinicopathological characteristics, treatment process, and prognosis of 14 GTN patients with brain metastases admitted to the West China Second University Hospital between January 2006 and December 2020.

Results

The median FIGO prognostic score was 15 points (range 11–21 points), with 12 cases having 13 points or more (extremely high risk). All patients received combination chemotherapy. The first-line regimen included 5-Fluorouracil, dactinomycin, and intrathecal methotrexate (5-FU + KSM + intrathecal MTX), and etoposide + methotrexate + actinomycin D/cyclophosphamide and vincristine (EMA-CO). Two patients died during the early period after diagnosis of brain metastases. A further patient with GTN Stage III failed to achieve a negative serum β human chorionic gonadotropin (hCG) after receiving chemotherapy in another hospital. Ten months after self-discontinuation of treatment, the disease progressed and she was admitted to our hospital with suspected liver and brain metastases, after which she abandoned treatment and was lost to follow-up. Among the remaining 11 patients, one relapsed once and two relapsed three times. Aside from the two patients who died and the one who was lost to follow-up, the remaining 11 patients had a median follow-up time of 89 months (range 35–148 months) and all achieved complete remission.

Conclusion

The overall survival rate of the patients in the present study was 78.57% through combination chemotherapy, symptomatic treatment, and co-treatment with brain radiotherapy for some patients. Enhancing the understanding of this disease and standardizing treatment are key to improving the overall survival rate of GTN patients with brain metastases.

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References

  1. Heller DS (2018) Update on the pathology of gestational trophoblastic disease. APMIS 126(7):647–654

    Article  Google Scholar 

  2. Lurain JR (2010) Gestational trophoblastic disease I: epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease, and management of hydatidiform mole. Am J Obstet Gynecol 203(6):531–539

    Article  Google Scholar 

  3. Lurain JR (2011) Gestational trophoblastic disease II: classification and management of gestational trophoblastic neoplasia. Am J Obstet Gynecol 204(1):11–18

    Article  Google Scholar 

  4. Kong Y et al (2017) Clinical characteristics and prognosis of ultra high-risk gestational trophoblastic neoplasia patients: a retrospective cohort study. Gynecol Oncol 146(1):81–86

    Article  Google Scholar 

  5. Piura E et al (2014) Brain metastases from gestational trophoblastic neoplasia: review of pertinent literature. Eur J Gynaecol Oncol 35(4):359–367

    CAS  PubMed  Google Scholar 

  6. Xiao C et al (2015) Management and prognosis of patients with brain metastasis from gestational trophoblastic neoplasia: a 24-year experience in Peking union medical college hospital. BMC Cancer 15:318

    Article  Google Scholar 

  7. Neubauer NL et al (2012) Brain metastasis in gestational trophoblastic neoplasia: an update. J Reprod Med 57(7–8):288–292

    PubMed  Google Scholar 

  8. Ngan HYS et al (2018) Update on the diagnosis and management of gestational trophoblastic disease. Int J Gynaecol Obstet 143(Suppl 2):79–85

    Article  Google Scholar 

  9. Braga A et al (2019) Challenges in the diagnosis and treatment of gestational trophoblastic neoplasia worldwide. World J Clin Oncol 10(2):28–37

    Article  Google Scholar 

  10. Gavanier D et al (2019) Gestational trophoblastic neoplasia with brain metastasis at initial presentation: a retrospective study. Int J Clin Oncol 24(2):153–160

    Article  Google Scholar 

  11. May T et al (2011) Current chemotherapeutic management of patients with gestational trophoblastic neoplasia. Chemother Res Pract 2011:806256

    PubMed  PubMed Central  Google Scholar 

  12. Frijstein MM et al (2019) Is there uniformity in definitions and treatment of gestational trophoblastic disease in Europe? Int J Gynecol Cancer 29(1):108–112

    Article  Google Scholar 

  13. NCCN clinical practice guidelines in oncology gestational trophoblastic neoplasia (2020)

  14. Ghorani E et al (2017) Pembrolizumab is effective for drug-resistant gestational trophoblastic neoplasia. The Lancet 390(10110):2343–2345

    Article  Google Scholar 

  15. Huang M (2017) complete serologic response to pembrolizumab in a woman with chemoresistant mestastatic choriocarinoma. J Clin Oncol 35(27):3172–3174

    Article  CAS  Google Scholar 

  16. Cheng HY et al (2020) Preliminary study of PD-1 inhibitor in the treatment of drug-resistant recurrent gestational trophoblastic neoplasia. Zhonghua Fu Chan Ke Za Zhi 55(6):390–394

    CAS  PubMed  Google Scholar 

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Funding

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Authors and Affiliations

  1. Ministry of Education Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Institute of Women and Children’s Health, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, 610041, China

    Ping Xiao, Tao Guo, Yan Luo, Mengpei Zhang & Rutie Yin

Authors
  1. Ping Xiao
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  2. Tao Guo
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  3. Yan Luo
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  4. Mengpei Zhang
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  5. Rutie Yin
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Contributions

PX collected data and wrote manuscript. TG, YL, and MZ collected data collecting. RY supervised manuscript review and editing. Five authors have read and approved the final manuscript.

Corresponding author

Correspondence to Rutie Yin.

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Conflicts of interest

The authors declare that they have no conflict of interest.

Ethics approval

The retrospective study was approved by Medical Ethics Committee of West China Second University Hospital, Sichuan University. Ethical Lot Number: 20200076.

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All the four authors are consent to participated in the study and for paper publication.

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Xiao, P., Guo, T., Luo, Y. et al. Real-world data of 14 cases of brain metastases from gestational trophoblastic neoplasia and a literature review. Arch Gynecol Obstet 305, 929–935 (2022). https://doi.org/10.1007/s00404-021-06238-w

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  • DOI: https://doi.org/10.1007/s00404-021-06238-w

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