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Review

The optimal management of brain metastases from gestational trophoblastic neoplasia

, ORCID Icon, , , , , , , , , ORCID Icon, , & ORCID Icon show all
Pages 307-315 | Received 27 Dec 2021, Accepted 02 Feb 2022, Published online: 13 Feb 2022

References

  • Bishop BN, Edemekong PF. Choriocarcinoma. [Updated 2021 Aug 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535434/
  • Brinton LA, Bracken MB, Connelly RR. Choriocarcinoma incidence in the United States. Am J Epidemiol. 1986Jun;123(6):1094–1100. PMID: 3706279.
  • Smith HO. Gestational trophoblastic disease epidemiology and trends. Clin Obstet Gynecol. 2003Sep;46(3):541–556. PMID: 12972736.
  • Goldstein DP, Berkowitz RS. Current management of gestational trophoblastic neoplasia. Hematol Oncol Clin North Am. 2012 Feb;26(1):111–131. Epub 2011 Nov 21.
  • Ngan HYS, Seckl MJ, Berkowitz RS, et al. Update on the diagnosis and management of gestational trophoblastic disease. PMID: 30306586, Int J Gynaecol Obstet. 2018 Oct;143(Suppl 2):79–85.
  • Berkowitz RS, Goldstein DP. Chorionic tumors. N Engl J Med. 1996 Dec 5;335(23):1740–1748. PMID: 8929267.
  • Piura E, Piura B. Brain metastases from gestational trophoblastic neoplasia: review of pertinent literature. Eur J Gynaecol Oncol. 2014;35(4):359–367. PMID: 25118474.
  • Lurain JR. Gestational trophoblastic disease I: epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease, and management of hydatidiform mole. Am J Obstet Gynecol. 2010Dec;203(6):531–539. Epub 2010 Aug 21. PMID: 20728069.
  • Lurain JR. Gestational trophoblastic disease II: classification and management of gestational trophoblastic neoplasia. Am J Obstet Gynecol. 2011Jan;204(1):11–18. Epub 2010 Aug 24. PMID: 20739008.
  • Neubauer NL, Latif N, Kalakota K, et al. Brain metastasis in gestational trophoblastic neoplasia: an update. J Reprod Med. 2012 Jul-Aug;57(7–8):288–292. PMID: 22838242.
  • Newlands ES, Holden L, Seckl MJ, et al. Management of brain metastases in patients with high-risk gestational trophoblastic tumors. J Reprod Med. 2002 Jun;47(6):465–471. PMID: 12092015.
  • Savage P, Kelpanides I, Tuthill M, et al. Brain metastases in gestational trophoblast neoplasia: an update on incidence, management and outcome. Gynecol Oncol. 2015Apr;137(1):73–76. Epub 2015 Jan 15. PMID: 25598530.
  • Gwacham NI, Van Brunt L, Ernst Y, et al. Leptomeningeal spread of gestational trophoblastic neoplasia in a 19-year old woman. Gynecol Oncol Rep. 2019 Jun 13;29:29–33. PMID: 31245524; PMCID: PMC6582189.
  • Gamer EI, Garrett A, Goldstein DP, et al. Significance of chest computed tomography findings in the evaluation and treatment of persistent gestational trophoblastic neoplasia. J Reprod Med. 2004 Jun;49(6):411–414. PMID: 15283046.
  • Ngan HY, Chan FL, Au VW, et al. Clinical outcome of micrometastasis in the lung in stage IA persistent gestational trophoblastic disease. Gynecol Oncol. 1998Aug;70(2):192–194. PMID: 9740689.
  • Braga A, Elias KM, Horowitz NS, et al. When less is more: regarding the use of chest X-ray instead of computed tomography in screening for pulmonary metastasis in postmolar gestational trophoblastic neoplasia. Br J Cancer. 2021 Mar;124(6):1033–1034.
  • Dhillon T, Palmieri C, Sebire NJ, et al. Value of whole body 18FDG-PET to identify the active site of gestational trophoblastic neoplasia. J Reprod Med. 2006 Nov;51(11):879–887. PMID: 17165434.
  • Mapelli P, Mangili G, Picchio M, et al. Role of 18F-FDG PET in the management of gestational trophoblastic neoplasia. Eur J Nucl Med Mol Imaging. 2013Apr;40(4):505–513. Epub 2013 Jan 12. PMID: 23314259.
  • Bakri Y, Al-hawashim N, Berkowitz R. CSF/serum beta-hCG ratio in patients with brain metastases of gestational trophoblastic tumor. J Reprod Med. 2000 Feb;45(2):94–96. PMID: 10710737.
  • Bagshawe KD, Harland S. Immunodiagnosis and monitoring of gonadotrophin-producing metastases in the central nervous system. Cancer. 1976Jul;38(1):112–118. PMID: 985735.
  • NCCN guidelines gestational trophoblastic neoplasia version 1. 2022, 2021 Oct
  • Hongzhao S, Baozhen W. Brain metastasis in choriocarcinoma and malignant mole: an analysis of 98 cases. Chin Med J (Engl). 1979 Mar;92(3):164–174. PMID: 221157.
  • Jones WB, Wagner-Reiss KM, Jl L Jr. Intracerebral choriocarcinoma. Gynecol Oncol. 1990Aug;38(2):234–243. Erratum in: Gynecol Oncol 1991 Jan;40(1):100. PMID: 2167282.
  • Athanassiou A, Begent RH, Newlands ES, et al. Central nervous system metastases of choriocarcinoma. 23 years’ experience at Charing Cross Hospital. Cancer. 1983 Nov 1;52(9):1728–1735. PMID: 6684500.
  • Bakri Y, Berkowitz RS, Goldstein DP, et al. Brain metastases of gestational trophoblastic tumor. J Reprod Med. 1994 Mar;39(3):179–184. PMID: 7518516.
  • Gavanier D, Leport H, Massardier J, et al. Gestational trophoblastic neoplasia with brain metastasis at initial presentation: a retrospective study. Epub 2018 Sep 21. PMID: 30242539, Int J Clin Oncol. 2019 Feb;24(2):153–160.
  • Liu TL, Deppe G, Chang QT, et al. Cerebral metastatic choriocarcinoma in the People’s Republic of China. Gynecol Oncol. 1983Apr;15(2):166–170. PMID: 6682069.
  • Small Jr W Jr, Lurain JR, and Shetty RM, et al. Gestational trophoblastic disease metastatic to the brain. Radiology. 1996Jul;200(1):277–280. PMID: 8657926.
  • Bolze PA, Riedl C, Massardier J, et al. Mortality rate of gestational trophoblastic neoplasia with a FIGO score of ≥13. Epub 2015 Oct 1. PMID: 26433171, Am J Obstet Gynecol. 2016 Mar;214(3):390.e1–8.
  • Brewer JI, Eckman TR, Dolkart RE, et al. Gestational trophoblastic disease. Am J Obstet Gynecol. 1971 Jan;109(2):335–340.
  • Freitas F, Braga A, Viggiano M, et al. Gestational trophoblastic neoplasia lethality among Brazilian women: a retrospective national cohort study. Gynecol Oncol. 2020 Aug;158(2):452–459.
  • Xiao C, Yang J, Zhao J, et al. Management and prognosis of patients with brain metastasis from gestational trophoblastic neoplasia: a 24-year experience in Peking union medical college hospital. BMC Cancer. 2015 Apr 28;15:318. PMID: 25927660; PMCID: PMC4416412.
  • Li J, Yue H, Wang X, et al. Chemotherapy for gestational trophoblastic neoplasia patients with a FIGO score of 12 or greater: a multistudy analysis. Eur J Obstet Gynecol Reprod Biol. 2019 Jul; 238: 164–169. Epub 2019 May 20. PMID: 31136884.
  • Deng L, Zhang J, Wu T, et al. Combination chemotherapy for primary treatment of high-risk gestational trophoblastic tumour. Cochrane Database Syst Rev. 2013 Jan;31(1):CD005196. PMID: 23440800. **Cochrane review of systemic therapy for high-risk GTN.
  • Curry SL, Blessing JA, DiSaia PJ, et al. A prospective randomized comparison of methotrexate, dactinomycin, and chlorambucil versus methotrexate, dactinomycin, cyclophosphamide, doxorubicin, melphalan, hydroxyurea, and vincristine in “poor prognosis” metastatic gestational trophoblastic disease: a Gynecologic oncology group study. Obstet Gynecol. 1989 Mar;73(3 Pt 1):357–362. PMID: 2536911.
  • Soni PD, Hartman HE, Dess RT, et al. Comparison of population-based observational studies with randomized trials in oncology. J Clin Oncol. 2019 May 10;37(14):1209–1216. Epub 2019 Mar 21. PMID: 30897037; PMCID: PMC7186578.
  • Alifrangis C, Agarwal R, Short D, et al. EMA/CO for high-risk gestational trophoblastic neoplasia: good outcomes with induction low-dose etoposide-cisplatin and genetic analysis. J Clin Oncol. 2013 Jan 10;31(2):280–286. Epub 2012 Dec 10. PMID: 23233709.
  • Bolis G, Bonazzi C, Landoni F, et al. EMA/CO regimen in high-risk gestational trophoblastic tumor (GTT). Gynecol Oncol. 1988Nov;31(3):439–444. PMID: 2846414.
  • Cagayan MS. High-risk metastatic gestational trophoblastic neoplasia. Primary management with EMA-CO (etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine) chemotherapy. J Reprod Med. 2012 May-Jun;57(5–6):231–236. PMID: 22696818.
  • Escobar PF, Lurain JR, Singh DK, et al. Treatment of high-risk gestational trophoblastic neoplasia with etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine chemotherapy. Gynecol Oncol. 2003Dec;91(3):552–557. PMID: 14675675.
  • Kim SJ, Bae SN, Kim JH, et al. Risk factors for the prediction of treatment failure in gestational trophoblastic tumors treated with EMA/CO regimen. Gynecol Oncol. 1998Nov;71(2):247–253. PMID: 9826467.
  • Lu WG, Ye F, Shen YM, et al. EMA-CO chemotherapy for high-risk gestational trophoblastic neoplasia: a clinical analysis of 54 patients. Int J Gynecol Cancer. 2008Mar-Apr;18(2):357–362. Epub 2007 Aug 17. PMID: 17711444.
  • Lurain JR, Singh DK, Schink JC. Primary treatment of metastatic high-risk gestational trophoblastic neoplasia with EMA-CO chemotherapy. J Reprod Med. 2006 Oct;51(10):767–772. PMID: 17086804.
  • Matsui H, Suzuka K, Iitsuka Y, et al. Combination chemotherapy with methotrexate, etoposide, and actinomycin D for high-risk gestational trophoblastic tumors. Gynecol Oncol. 2000Jul;78(1):28–31. PMID: 10873405.
  • Newlands ES, Bagshawe KD, Begent RH, et al. Results with the EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) regimen in high risk gestational trophoblastic tumours, 1979 to 1989. Br J Obstet Gynaecol. 1991Jun;98(6):550–557. PMID: 1651757.
  • Turan T, Karacay O, Tulunay G, et al. Results with EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) chemotherapy in gestational trophoblastic neoplasia. Int J Gynecol Cancer. 2006May-Jun;16(3):1432–1438. PMID: 16803542.
  • Tetef ML, Margolin KA, Doroshow JH, et al. Pharmacokinetics and toxicity of high-dose intravenous methotrexate in the treatment of leptomeningeal carcinomatosis. Cancer Chemother Pharmacol. 2000;46(1):19–26. PMID: 10912573.
  • Gillespie AM, Siddiqui N, Coleman RE, et al. Gestational trophoblastic disease: does central nervous system chemoprophylaxis have a role? Br J Cancer. 1999Mar;79(7–8):1270–1272. PMID: 10098770; PMCID: PMC2362241.
  • Mangili G, Lorusso D, Brown J, et al. Trophoblastic disease review for diagnosis and management: a joint report from the International society for the study of trophoblastic disease, european organisation for the treatment of trophoblastic disease, and the gynecologic cancer intergroup. Int J Gynecol Cancer. 2014Nov;24(9 Suppl 3):S109–16. PMID: 25341573.
  • Seckl MJ, Sebire NJ, Berkowitz RS. Gestational trophoblastic disease. Lancet. 2010 Aug 28;376(9742):717–729. Epub 2010 Jul 29. PMID: 20673583.
  • Bolze PA, Attia J, Massardier J, et al. Formalised consensus of the European organisation for treatment of trophoblastic diseases on management of gestational trophoblastic diseases. Eur J Cancer. 2015Sep;51(13):1725–1731. Epub 2015 Jun 16. PMID: 26092638.
  • Schuman S, Pearson JM, Lucci JA 3rd, et al. Metastatic gestational trophoblastic neoplasia complicated by tumor lysis syndrome, heart failure, and thyrotoxicosis: a case report. J Reprod Med. 2010 Sep-Oct;55(9–10):441–444. PMID: 21043373.
  • Mao Y, Wan X, Lv W, et al. Relapsed or refractory gestational trophoblastic neoplasia treated with the etoposide and cisplatin/etoposide, methotrexate, and actinomycin D (EP-EMA) regimen. Int J Gynaecol Obstet. 2007Jul;98(1):44–47. Epub 2007 May 3. PMID: 17481633.
  • Newlands ES, Mulholland PJ, Holden L, et al. Etoposide and cisplatin/etoposide, methotrexate, and actinomycin D (EMA) chemotherapy for patients with high-risk gestational trophoblastic tumors refractory to EMA/cyclophosphamide and vincristine chemotherapy and patients presenting with metastatic placental site trophoblastic tumors. J Clin Oncol. 2000Feb;18(4):854–859. PMID: 10673528.
  • Wang J, Short D, Sebire NJ, et al. Salvage chemotherapy of relapsed or high-risk gestational trophoblastic neoplasia (GTN) with paclitaxel/cisplatin alternating with paclitaxel/etoposide (TP/TE). Ann Oncol. 2008Sep;19(9):1578–1583. Epub 2008 May 2. PMID: 18453518.
  • Rathod PS, Kundargi R, Pallavi VR, et al. Refractory gestational trophoblastic neoplasia: a novel drug combination with paclitaxel and carboplatin produces durable complete remission. Int J Gynecol Cancer. 2015Nov;25(9):1737–1741. PMID: 26401644.
  • El-Helw LM, Seckl MJ, Haynes R, et al. High-dose chemotherapy and peripheral blood stem cell support in refractory gestational trophoblastic neoplasia. Br J Cancer. 2005 Sep 19;93(6):620–621. PMID: 16222307; PMCID: PMC2361618.
  • Anantharaju AA, Pallavi VR, Bafna UD, et al. Role of salvage therapy in chemo resistant or recurrent high-risk gestational trophoblastic neoplasm. Int J Gynecol Cancer. 2019Mar;29(3):547–553. Epub 2019 Jan 29. PMID: 30700567.
  • Lurain JR, Schink JC. Importance of salvage therapy in the management of high-risk gestational trophoblastic neoplasia. J Reprod Med. 2012 May-Jun;57(5–6):219–224. PMID: 22696816.
  • Bolze PA, Patrier S, Massardier J, et al. PD-L1 expression in premalignant and malignant trophoblasts from gestational trophoblastic diseases is ubiquitous and independent of clinical outcomes. Int J Gynecol Cancer. 2017Mar;27(3):554–561. PMID: 28060141.
  • Veras E, Kurman RJ, Wang TL, et al. PD-L1 expression in human placentas and gestational trophoblastic diseases. Int J Gynecol Pathol. 2017Mar;36(2):146–153. PMID: 27362903; PMCID: PMC5518625.
  • Ghorani E, Kaur B, Fisher RA, et al. Pembrolizumab is effective for drug-resistant gestational trophoblastic neoplasia. Lancet. 2017 Nov 25;390(10110):2343–2345. PMID: 29185430.
  • You B, Bolze PA, Lotz JP, et al. Avelumab in patients with gestational trophoblastic tumors with resistance to single-agent chemotherapy: cohort A of the TROPHIMMUN Phase II Trial. J Clin Oncol. 2020 Sep 20;38(27):3129–3137. Epub 2020 Jul 27. PMID: 32716740; PMCID: PMC7499607.
  • Cheng H, Zong L, Kong Y, et al. Camrelizumab plus apatinib in patients with high-risk chemorefractory or relapsed gestational trophoblastic neoplasia (CAP 01): a single-arm, open-label, phase 2 trial. Lancet Oncol. 2021Nov;22(11):1609–1617. Epub 2021 Oct 5. PMID: 34624252.
  • Worley Jr MJ, Elias KM, Horowitz NS, et al. Durable remission for a woman with refractory choriocarcinoma treated with anti-endoglin monoclonal antibody and bevacizumab: a case from the New England trophoblastic disease center, brigham and women’s hospital and dana-farber cancer institute. Gynecol Oncol. 2018Jan;148(1):5–11. Epub 2017 Dec 6. PMID: 29217138.
  • Seckl MJ, Sebire NJ, Fisher RA, et al.; ESMO Guidelines Working Group. Gestational trophoblastic disease: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013 Oct;24(Suppl 6):vi39–50. Epub 2013 Sep 1. PMID: 23999759. .
  • Schechter NR, Mychalczak B, Jones W, et al. Prognosis of patients treated with whole-brain radiation therapy for metastatic gestational trophoblastic disease. Gynecol Oncol. 1998Feb;68(2):183–192. PMID: 9514808.
  • Hertz R, Lewis J Jr, Lipsett MB. Five year’s experience with the chemotherapy of metastatic choriocarcinoma and related trophoblastic tumors in women. Am J Obstet Gynecol. 1961 Sep; 82: 631–640. PMID: 13713828.
  • Rall DP. Conference on obstacles to the control of acute leukemia. Experimental studies of the blood-brain barrier. Cancer Res. 1965 Oct;25(9):1572–1577. PMID: 5861080.
  • Brace KC. The role of irradiation in the treatment of metastatic trophoblastic disease. Radiology. 1968;91:540–544.
  • Berkowitz RS, Goldstein DP, Bernstein MR. Choriocarcinoma following term gestation. Gynecol Oncol. 1984Jan;17(1):52–57. PMID: 6319246.
  • Hammond CB, Borchert LG, Tyrey L, et al. Treatment of metastatic trophoblastic disease: good and poor prognosis. Am J Obstet Gynecol. 1973 Feb 15;115(4):451–457. PMID: 4346614.
  • Lurain JR, Brewer JI, Mazur MT, et al. Fatal gestational trophoblastic disease: an analysis of treatment failures. Am J Obstet Gynecol. 1982 Oct 15;144(4):391–395. PMID: 6289666.
  • Rustin GJ, Newlands ES, Begent RH, et al. Weekly alternating etoposide, methotrexate, and actinomycin/vincristine and cyclophosphamide chemotherapy for the treatment of CNS metastases of choriocarcinoma. J Clin Oncol. 1989Jul;7(7):900–903. PMID: 2472471.
  • Surwit EA, Hammond CB. Treatment of metastatic trophoblastic disease with poor prognosis. Obstet Gynecol. 1980 May;55(5):565–570. PMID: 6245395.
  • JC W Jr, Woodward KT, Hammond CB. Choriocarcinoma metastatic to the brain: therapy and prognosis. Semin Oncol. 1982 Jun;9(2):208–212. PMID: 7123268.
  • EL Y Jr, Schlaerth J, Gaddis O, et al. Radiation therapy in the management of gestational choriocarcinoma metastatic to the central nervous system. Obstet Gynecol. 1987 Apr;69(4):627–630. PMID: 3822306.
  • Soper JT, Spillman M, Sampson JH, et al. High-risk gestational trophoblastic neoplasia with brain metastases: individualized multidisciplinary therapy in the management of four patients. Gynecol Oncol. 2007Mar;104(3):691–694. Epub 2006 Nov 29. PMID: 17137617.
  • Neubauer NL, Strohl AE, Schink JC, et al. Fatal gestational trophoblastic neoplasia: an analysis of treatment failures at the Brewer Trophoblastic Disease Center from 1979-2012 compared to 1962-1978. Gynecol Oncol. 2015;138(2):339–342.
  • Altintaş A, Vardar MA. Central nervous system involvement in gestational trophoblastic neoplasia. Eur J Gynaecol Oncol. 2001;22(2):154–156. PMID: 11446484.
  • AC E Jr, Soper JT, Clarke-Pearson DL, et al. Gestational trophoblastic disease metastatic to the central nervous system. Gynecol Oncol. 1995Nov;59(2):226–230. PMID: 7590478.
  • Aoyama H, Tago M, Kato N, et al. Neurocognitive function of patients with brain metastasis who received either whole brain radiotherapy plus stereotactic radiosurgery or radiosurgery alone. Int J Radiat Oncol Biol Phys. 2007 Aug 1;68(5):1388–1395. PMID: 17674975.
  • Chang EL, Wefel JS, Hess KR, et al. Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol. 2009Nov;10(11):1037–1044. Epub 2009 Oct 2. PMID: 19801201.
  • Brown PD, Pugh S, Laack NN, et al.; Radiation Therapy Oncology Group (RTOG). Memantine for the prevention of cognitive dysfunction in patients receiving whole-brain radiotherapy: a randomized, double-blind, placebo-controlled trial. Neuro Oncol. 2013 Oct;15(10):1429–1437. Epub 2013 Aug 16. PMID: 23956241; PMCID: PMC3779047.
  • Brown PD, Gondi V, Pugh S, et al.; for NRG Oncology. Hippocampal avoidance during whole-brain radiotherapy plus memantine for patients with brain metastases: phase III trial NRG oncology CC001. J Clin Oncol. 2020 Apr 1;38(10):1019–1029. Epub 2020 Feb 14. PMID: 32058845; PMCID: PMC7106984.
  • Song L, Li Q, Yin R, et al. Choriocarcinoma with brain metastasis after term pregnancy: a case report. Medicine (Baltimore). 2018Oct;97(42):e12904. PMID: 30335019; PMCID: PMC6211910.
  • Ngwa W, Irabor OC, Schoenfeld JD, et al. Using immunotherapy to boost the abscopal effect. Nat Rev Cancer. 2018May;18(5):313–322. Epub 2018 Feb 16. PMID: 29449659; PMCID: PMC5912991.
  • US Food and Drug Administration. (2017) ‘22 case studies where Phase 2 and Phase 3 trials had divergent results.’

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