Jones W B, Wagner-Reiss K M, Lewis J L
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021.
Gynecol Oncol. 1990 Aug;38(2):234-43. doi: 10.1016/0090-8258(90)90048-p.
Nineteen patients with gestational trophoblastic disease (GTD) metastatic to the brain are reviewed. These patients constituted 9.0% of 210 [corrected] patients with GTD treated between November 1967 and December 1987. Four patients (21%) presented with primary neurological symptoms of GTD; four patients developed brain metastases during or after treatment with first drug(s) therapy; and 11 patients developed CNS metastases after resistance to initial chemotherapy. The initial chemotherapy in three of four patients who presented with brain metastases was with the combination of methotrexate, actinomycin D, and chlorambucil (MAC). Of the 15 patients who developed brain metastases after prior chemotherapy, 12 had received MAC at least once prior to the diagnosis of brain metastases, and in 5 patients, MAC was the first chemotherapy given after the diagnosis of brain metastases. All of the patients received whole-brain radiotherapy. Five of nineteen patients (26.3%) are living and well 4 to 15 years after the diagnosis of brain metastases. One of four patients (25%) who presented with brain metastases survived. These results suggest that MAC chemotherapy did not prevent the development of brain metastases in some of the patients and was less than optimal therapy in those whose brain tumor had become resistant to other cytotoxic agents.
对19例发生脑转移的妊娠滋养细胞疾病（GTD）患者进行了回顾性研究。这些患者占1967年11月至1987年12月期间接受治疗的210例[校正后]GTD患者的9.0%。4例（21%）患者以GTD的原发性神经症状就诊；4例患者在使用一线药物治疗期间或之后发生脑转移；11例患者在对初始化疗耐药后发生中枢神经系统转移。4例出现脑转移的患者中，3例的初始化疗采用甲氨蝶呤、放线菌素D和苯丁酸氮芥联合方案（MAC）。在先前化疗后发生脑转移的15例患者中，12例在脑转移诊断前至少接受过一次MAC治疗，5例患者在脑转移诊断后首次给予的化疗为MAC。所有患者均接受了全脑放疗。19例患者中有5例（26.3%）在脑转移诊断后4至15年仍存活且状况良好。4例出现脑转移的患者中有1例（25%）存活。这些结果表明，MAC化疗未能在部分患者中预防脑转移的发生，对于脑肿瘤已对其他细胞毒性药物耐药的患者，MAC化疗并非最佳治疗方案。
