Déborah Gavanier1, Hélène Leport1, Jérome Massardier2,3, Fatima Abbas4, Anne-Marie Schott2,4, Touria Hajri2, François Golfier5,6, Pierre-Adrien Bolze1,2. 1. Department of Gynecological Surgery and Oncology, Obstetrics, University of Lyon 1, University Hospital Lyon Sud, Pierre-Bénite, France. 2. French Centre for Trophoblastic Diseases, University Hospital Lyon Sud, 165, Chemin du Grand Revoyet, Bâtiment 3B, 2ème étage, 69495, Pierre-Bénite, France. 3. Department of Prenatal Diagnosis, University Hospital Femme Mere Enfant, Bron, France. 4. Pôle Information Médicale Evaluation Recherche, Equipe d'Accueil 4129, Hospices Civils de Lyon, Lyon, France. 5. Department of Gynecological Surgery and Oncology, Obstetrics, University of Lyon 1, University Hospital Lyon Sud, Pierre-Bénite, France. francois.golfier@chu-lyon.fr. 6. French Centre for Trophoblastic Diseases, University Hospital Lyon Sud, 165, Chemin du Grand Revoyet, Bâtiment 3B, 2ème étage, 69495, Pierre-Bénite, France. francois.golfier@chu-lyon.fr.
Abstract
OBJECTIVE: To evaluate the survival and functional outcome of patients with brain metastasis due to gestational trophoblastic neoplasia (GTN). METHODS: A 17-year retrospective study based on case review of women with brain metastasis from GTN identified by the electronic databases held in the French Reference Centre. PRIMARY OUTCOME MEASURE: 5-year overall survival calculated with the Kaplan-Meier method. SECONDARY OUTCOME MEASURES: causes of death, prognostic factors and functional outcomes. RESULTS: 21 patients had GTN brain metastasis and were treated with multidrug chemotherapy without concomitant whole-brain radiation therapy. Three patients died early (< 4 weeks) of cerebral hemorrhage, 3 died ≥ 1 months after treatment initiation and 15 were alive at the date of last contact. The overall survival rate at 5 years was 69.8% (95% CI 44.3-85.3). After excluding early deaths, the survival rate at 5 years was 81.5% (95% CI 52.3-93.7). No predictive factor of survival was identified. Although 11 of the 12 (92%) surviving patients contacted still reported sequelae, nine of them (75%) had resumed a normal life. CONCLUSIONS: After excluding early deaths, this study implies a high survival rate in patients with brain metastasis from GTN. These results were achieved in the total absence of whole-brain radiotherapy and almost completely without the need for intrathecal methotrexate.
OBJECTIVE: To evaluate the survival and functional outcome of patients with brain metastasis due to gestational trophoblastic neoplasia (GTN). METHODS: A 17-year retrospective study based on case review of women with brain metastasis from GTN identified by the electronic databases held in the French Reference Centre. PRIMARY OUTCOME MEASURE: 5-year overall survival calculated with the Kaplan-Meier method. SECONDARY OUTCOME MEASURES: causes of death, prognostic factors and functional outcomes. RESULTS: 21 patients had GTN brain metastasis and were treated with multidrug chemotherapy without concomitant whole-brain radiation therapy. Three patients died early (< 4 weeks) of cerebral hemorrhage, 3 died ≥ 1 months after treatment initiation and 15 were alive at the date of last contact. The overall survival rate at 5 years was 69.8% (95% CI 44.3-85.3). After excluding early deaths, the survival rate at 5 years was 81.5% (95% CI 52.3-93.7). No predictive factor of survival was identified. Although 11 of the 12 (92%) surviving patients contacted still reported sequelae, nine of them (75%) had resumed a normal life. CONCLUSIONS: After excluding early deaths, this study implies a high survival rate in patients with brain metastasis from GTN. These results were achieved in the total absence of whole-brain radiotherapy and almost completely without the need for intrathecal methotrexate.
Entities:
Keywords:
Brain metastases; Choriocarcinoma; Gestational trophoblastic neoplasia; Quality of life