Irradiation of liver metastases due to gestational choriocarcinoma.

One of the major unresolved problems in high-risk choriocarcinoma is the prevention of hemorrhage from tumor necrosis during chemotherapy. The authors report a successfully treated patient who developed intrahepatic bleeding while receiving systemic chemotherapy and concomitant whole liver irradiation. Patients with trophoblastic liver metastases are at risk for bleeding from tumor necrosis during chemotherapy but, because there are few reported cases, the degree of risk cannot be predicted. Radiation therapy for the prevention of this complication may not be as successful for liver metastases as it is for brain metastases; reports are too scarce to evaluate its efficacy. As demonstrated in the present patient, radiation therapy does not completely eliminate the risk of hemorrhage from chemotherapy. The hypothesis that patients with liver metastases from gestational choriocarcinoma are more susceptible to treatment failure and life-threatening complications than other members of the high-risk category needs support. Other investigators are encouraged to report their results with trophoblastic liver metastases to clarify the type and degree of risk, to determine the role of adjuvant radiation therapy, and to establish optimum treatment protocols.