From Uterus to Brain: An Update on Epidemiology, Clinical Features, and Treatment of Brain Metastases From Gestational Trophoblastic Neoplasia

Fulvio Borella; Stefano Cosma; Domenico Ferraioli; Mario Preti; Niccolò Gallio; Giorgio Valabrega; Giulia Scotto; Alessandro Rolfo; Isabella Castellano; Paola Cassoni; Luca Bertero; Chiara Benedetto

doi:10.3389/fonc.2022.859071

From Uterus to Brain: An Update on Epidemiology, Clinical Features, and Treatment of Brain Metastases From Gestational Trophoblastic Neoplasia

Front Oncol. 2022 Apr 13:12:859071. doi: 10.3389/fonc.2022.859071. eCollection 2022.

Authors

Fulvio Borella^{1

2}, Stefano Cosma^{1

2}, Domenico Ferraioli³, Mario Preti^{1

2}, Niccolò Gallio^{1

2}, Giorgio Valabrega⁴, Giulia Scotto⁴, Alessandro Rolfo², Isabella Castellano⁵, Paola Cassoni⁵, Luca Bertero⁵, Chiara Benedetto^{1

2}

Affiliations

¹ Division of Gynecology and Obstetrics 1, "City of Health and Science University Hospital", University of Turin, Turin, Italy.
² Department of Surgical Sciences, University of Turin, Turin, Italy.
³ Department of Oncology Surgery, Centre Léon Berard (CLB), Lyon, France.
⁴ Department of Oncology, University of Torino, Torino, Italy.
⁵ Pathology Unit, Department of Medical Sciences, "City of Health and Science University Hospital", University of Turin, Turin, Italy.

Abstract

In this review, we provide the state of the art about brain metastases (BMs) from gestational trophoblastic neoplasia (GTN), a rare condition. Data concerning the epidemiology, clinical presentation, innovations in therapeutic modalities, and outcomes of GTN BMs are comprehensively presented with particular attention to the role of radiotherapy, neurosurgery, and the most recent chemotherapy regimens. Good response rates have been achieved thanks to multi-agent chemotherapy, but brain involvement by GTNs entails significant risks for patients' health since sudden and extensive intracranial hemorrhages are possible. Moreover, despite the evolution of treatment protocols, a small proportion of these patients ultimately develops a resistant disease. To tackle this unmet clinical need, immunotherapy has been recently proposed. The role of this novel option for this subset of patients as well as the achieved results so far are also discussed.

Keywords: brain metastases (BMs); chemotherapy; choriocarcinoma; gestational trophoblastic neoplasia; immunotherapy; treatment outcomes.

Publication types

Review