Intracranial metastasis of choriocarcinoma. A clinicopathologic study.

In an attempt to improve the diagnosis and treatment of intracranial metastases of choriocarcinoma, the authors carried out a clinicopathologic investigation of 36 patients with choriocarcinoma metastasized in the brain. Analysis on the autopsy findings of 30 cases with documented intracranial metastases of choriocarcinoma proved neurosurgical resectability in most cases. After initiation of the clinical use of dactinomycin in 1965, 5 of 10 patients in the surgically treated group, and 1 of 17 in the group without surgery, survived for more than 6 months after development of neurologic symptoms. Intracranial metastases of choriocarcinoma should be treated as follows: (1) if symptoms of increased intracranial pressure progress to a life-threatening situation, removal of tumor or, at least, decompression should be immediately performed; (2) multidrug chemotherapy supplemented by whole-brain irradiation should be started within several days after surgery; and (3) if symptoms are not present, chemotherapy combined with irradiation is the first treatment of choice.