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ORIGINAL ARTICLE
Year : 2022  |  Volume : 46  |  Issue : 4  |  Page : 147-161

Clinical characteristics, management, and outcome of gestational trophoblastic neoplasia patients with brain metastasis: A 10-year experience at the Philippine General Hospital


Division of Trophoblastic Diseases, Department of Obstetrics and Gynecology, Philippine General Hospital, University of the Philippines, Manila, Philippines

Correspondence Address:
Gisele V Gonzales-Acantilado
Department of Obstetrics and Gynecology, Philippine General Hospital, University of the Philippines, Taft Avenue, Ermita, Manila 1000
Philippines
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/pjog.pjog_31_22

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OBJECTIVE: This study aimed to determine the clinical characteristics, management, and outcome of gestational trophoblastic neoplasia (GTN) patients with brain metastasis. MATERIALS AND METHODS: This was a 10-year descriptive study that included all patients with brain metastasis from GTN. Patients' sociodemographic and clinicopathological profiles were described. Using Kaplan–Meier survival curve, the survival time was determined. RESULTS: From January 1, 2010, to December 31, 2019, there were 33 GTN patients with brain metastasis. Four were excluded from the study due to incomplete records. Twenty-nine patients were included in the study. Nineteen (65.51%) patients presented with neurologic symptoms upon diagnosis and one (3.44%) during treatment. All received etoposide, methotrexate, actinomycin, oncovin (EMACO) as first-line treatment. Five (17.24%) patients were given induction chemotherapy with low-dose etoposide–cisplatin. Seventeen (58.62%) patients underwent whole-brain radiation and two (6.89%) were given intrathecal methotrexate. Thirteen patients (44.82%) achieved biochemical remission with EMACO chemotherapy. Four patients (13.79%) had resistance to EMACO and were given Etoposide Cisplatin Etoposide Methotrexate Actinomycin (EP EMA). Four patients (13.79%) underwent an adjunctive hysterectomy. Four patients (13.79%) died during treatment. One patient (3.44%) was unable to continue her chemotherapy because she got pregnant before her first consolidation course. There were eight early deaths (<4 weeks of admission) and hence were excluded in the analysis. Three patients who went into biochemical remission relapsed on the 1st, 2nd, and 3rd months after their last consolidation course, respectively. The median follow-up time was 27 months. After excluding early deaths, the survival rate between 3 and 7 years after treatment is at 61.9%. The mean survival time was 5.43 years. Six surviving patients were contacted. Five (17.24%) of them had resumed their everyday life, and one is currently undergoing chemotherapy. CONCLUSION: The study was able to document brain metastasis from GTN to be 14.28% (29/203) among metastatic high-risk admissions. The biochemical remission rate from first-line treatment was of 61.90% (13/21) and resistance rate was 19.04% (4/21). Lost to follow up after achieving biochemical remission was a challenge encountered.


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