Athanassiou A, Begent R H, Newlands E S, Parker D, Rustin G J, Bagshawe K D
Cancer. 1983 Nov 1;52(9):1728-35. doi: 10.1002/1097-0142(19831101)52:9<1728::aid-cncr2820520929>3.0.co;2-u.
Between 1957 and February 1981, 782 patients received cytotoxic chemotherapy for gestational trophoblastic tumors (GTT) in the Department of Medical Oncology, Charing Cross Hospital (London, England). Sixty-nine (8.8%) patients had central nervous system (CNS) metastases. Thirty-three of them (48%) presented with CNS disease prior to treatment (CNS presentation group), and 36 (52%) developed CNS disease while on treatment, or relapsed in the CNS after an initial complete or partial remission (late CNS group). Treatment included systemic and intrathecal chemotherapy, and, in several cases neurosurgery, whole brain irradiation, and immunotherapy. Life-table analysis projects an overall survival of 49% for the CNS presentation group and 6% for the late CNS group. Prognosis has improved with time; prior to 1974, 38% of the CNS presentation group and none of the late CNS group survived. After 1974 overall survival has been 80% in the CNS presentation group and 25% in the late CNS group. The principal elements in the successful management of such cases are: (1) CNS prophylaxis with intrathecal methotrexate for patients at risk of developing brain metastases; (2) early detection of CNS lesions by prompt recognition of their clinical features, measurement of the ratio of CSF to serum human chorionic gonadotropin concentration, and appropriate use of computerized tomography of the brain; and (3) a combination of systemic and intrathecal therapy for patients developing brain secondaries.
1957年至1981年2月期间，伦敦查令十字医院医学肿瘤学系有782例患者接受了针对妊娠滋养细胞肿瘤（GTT）的细胞毒性化疗。69例（8.8%）患者发生了中枢神经系统（CNS）转移。其中33例（48%）在治疗前出现CNS疾病（CNS表现组），36例（52%）在治疗期间发生CNS疾病，或在最初完全或部分缓解后CNS复发（晚期CNS组）。治疗包括全身和鞘内化疗，在一些病例中还包括神经外科手术、全脑放疗和免疫治疗。寿命表分析显示，CNS表现组的总生存率为49%，晚期CNS组为6%。随着时间的推移，预后有所改善；1974年前，CNS表现组的生存率为38%，晚期CNS组无一存活。1974年后，CNS表现组的总生存率为80%，晚期CNS组为25%。成功处理此类病例的主要因素包括：（1）对有发生脑转移风险的患者进行鞘内甲氨蝶呤中枢神经系统预防；（2）通过迅速识别其临床特征、测量脑脊液与血清人绒毛膜促性腺激素浓度比值以及适当使用脑部计算机断层扫描早期发现CNS病变；（3）对发生脑转移的患者采用全身和鞘内治疗相结合的方法。
