Gestational trophoblastic disease metastatic to the brain
Gestational trophoblastic disease metastatic to the brain
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DOI：
10.1148/radiology.200.1.8657926
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发表时间：
1996-07-01
期刊：
影响因子：
19.7
通讯作者：
Brand, WN
中科院分区：
文献类型：
--
作者：
Small, W;Lurain, JR;Brand, WN
目得：为了评估临床特征，治疗技术，并在患者妊娠滋养细胞疾病转移到brain.MATERIALS和METHODS：从1962年至1994年，26（4.1%）631例滋养细胞疾病接受治疗或发展脑转移的证据（患者年龄14-43岁）。所有患者均接受多药全身化疗和全脑放疗。总辐射剂量为2，386 - 4，000 cGy（每次200-300 cGy）。无患者接受鞘内化疗。患者被分为三组：A组，症状性脑转移，在介绍;组B，无症状或轻微症状的脑部疾病，在介绍;和C组，在全身化疗脑转移的发展。多变量分析结果表明，年龄，怀孕前的事件人绒毛膜促性腺激素水平，世界卫生组织评分，开颅手术的性能，脑转移瘤的数量并不影响生存。A组（39%）和B组（100%）的5年总生存率差异有统计学意义（P = 0.03）。结论：全身化疗和全脑放疗可治愈滋养细胞疾病脑转移。作者建议使用类固醇、化疗（依托泊苷、大剂量甲氨蝶呤[1 g/m2]、更生霉素、环磷酰胺和硫酸长春新碱）和同时全脑放疗（3，000 cGy/200 cGy）。
PURPOSE: To evaluate clinical characteristics, treatment technique, and results in patients with gestational trophoblastic disease metastatic to the brain.MATERIALS AND METHODS: From 1962 to 1994, 26 (4.1%) of 631 patients who underwent treatment for trophoblastic disease had or developed evidence of brain metastases (patients were aged 14-43 years). All patients received multiagent systemic chemotherapy and whole-brain irradiation. Total doses of radiation were 2,386-4,000 cGy (200-300 cGy per fraction). No patient received intrathecal chemotherapy. Patients were divided into three groups: group A, symptomatic brain metastases at presentation; group B, asymptomatic or minimally symptomatic brain disease at presentation; and group C, development of brain metastases during systemic chemotherapy.RESULTS: The overall 5-year actuarial survival rate was 51%. Multivariate analysis findings indicated that age, preceding pregnancy event human chorionic gonadotropin level, World Health Organization score, performance of craniotomy, and number of brain metastases did not influence survival. The difference in the 5-year overall survival rates between groups A (39%) and B (100%) was significant (P =.03).CONCLUSION: Gestational trophoblastic disease metastatic to the brain is curable with systemic chemotherapy and whole-brain irradiation. The authors suggest treatment with steroids, chemotherapy (etoposide, high-dose methotrexate [1 g/m(2)], dactinomycin, cyclophosphamide, and vincristine sulfate), and concurrent whole-brain irradiation (3,000 cGy in 200-cGy fractions).