Clinical management of GTN with brain metastasis: a 20 year experience in Peking Union Medical College Hospital, China 1 19 CLINICAL MANAGEMENT OF GTN WITH BRAIN METASTASIS: A 20-YEAR EXPERIENCE IN PEKING UNION MEDICAL COLLEGE HOSPITAL, CHINA

Gestational trophoblastic neoplasia (GTN) is remarkably sensitive to chemotherapy. Indeed,with current chemotherapy regimens, the cure rates are almost 100% in the lowrisk group and nearly 90% in the high-risk group. Brain metastasis from GTN is rare with an incidence of 3% to 21.4% and about only 222 cases documented in the literature. In our hospital, from January 1994 to December 2013, 97 GTN patients were identified as having brain metastasis, representing 3.4% of all patients treated with this cancer at our hospital during the same period. Metastatic disease to the brain from GTN was regarded as a poor prognostic indicator in previous reports, with survival rates significantly reduced as low as 35-60%. However, more recent reports suggest improved survival rates (e.g. Newlands et al J Reprod Med. 2002 Jun;47(6):465-71) and during the past 20 years we have achieved an overall five-year survival (OS) rate of 83.5% for patients receiving primary chemotherapy in our hospital. In addition, where we have given secondary salvage therapy to patients who have failed chemotherapy elsewhere, our 5 yr OS has been 53.3% (excluding 6 early deaths). In this chapter, we will describe our large experience and great success in the management of GTN patients with brain metastases over the past 20 years at the Peking Union Medical College (PUMC) Hospital.