Multimodal Treatment of Extragonadal Choriocarcinoma with Multiple Brain and Lung Metastases: A Case Report.

Choriocarcinoma is a highly aggressive germ cell tumor and can metastasize to the brain. Although brain metastasis has a poor prognosis, the optimal treatment strategy remains unclear due to its low incidence. A 33-year-old man presenting with multiple lung nodules on chest radiography was referred to our hospital. Computed tomography revealed bilateral lung nodules and a large pelvic mass, and brain magnetic resonance imaging (MRI) demonstrated multiple brain lesions. He developed progressive headache and nausea and underwent two craniotomies because of rapid tumor growth and intratumoral hemorrhage. Metastasis of choriocarcinoma was strongly suspected because of histological findings and detection of urine human chorionic gonadotropin (hCG). He immediately received chemotherapy with bleomycin, etoposide, and cisplatin (BEP). Although the pelvic mass and pulmonary lesions reduced in size and the β-hCG level decreased after one cycle of BEP, brain MRI displayed an increase in the size and number of brain metastases. He underwent whole-brain radiotherapy (WBRT) concurrently with 2 cycles of BEP, leading to successful reduction of brain metastases. After 4 cycles of BEP, the β-hCG level was still higher than the normal range, and the pelvic and pulmonary lesions remained. He continued chemotherapy with paclitaxel, ifosfamide, and cisplatin (TIP) and etoposide, ifosfamide, and cisplatin (VIP). The β-hCG level normalized, and the residual pelvic mass was resected, revealing no viable cancer cells. Multimodal treatment, including two craniotomies and chemotherapy concurrent with WBRT, can achieve good control of lesions of the brain and other sites.