Abstract：
Gestational Trophoblastic Neoplasia (GTN) is a rare group of malignant placental-related tumours requiring systemic anti-cancer treatment. Leptomeningeal disease (LMD) related to GTN is not well reported with no consensus in optimal treatment. We offer recommendations for management of these patients.
We discuss five patients with GTN who presented with features of LMD and were diagnosed with gadolinium-enhanced MRI brain, all of whom received low dose induction etoposide-cisplatin (EP) followed by either EP-etoposide, methotrexate (CNS) and actinomycin-D (EMA) or EMA(CNS)-cyclophosphamide and vincristine (CO).
Four out of the five patients additionally received intrathecal methotrexate. Four patients had complete hCG response to first line multi-agent chemotherapy, one patient required second line paclitaxel, cisplatin alternating with paclitaxel, etoposide (TP/TE), where paclitaxel was substituted with nab-paclitaxel due to anaphylaxis, followed by hysterectomy. One of the four initial complete hCG responders relapsed in the lung requiring further systemic treatment with subsequent lobectomy. Patient reported outcomes indicate persistent neurological symptoms are mild and do not affect functionality and quality of life.
With a follow-up range of 2-6 years, all five patients remain cured demonstrating excellent survival outcomes with the avoidance of whole-brain radiotherapy in all cases.
We discuss five patients with GTN who presented with features of LMD and were diagnosed with gadolinium-enhanced MRI brain, all of whom received low dose induction etoposide-cisplatin (EP) followed by either EP-etoposide, methotrexate (CNS) and actinomycin-D (EMA) or EMA(CNS)-cyclophosphamide and vincristine (CO).
Four out of the five patients additionally received intrathecal methotrexate. Four patients had complete hCG response to first line multi-agent chemotherapy, one patient required second line paclitaxel, cisplatin alternating with paclitaxel, etoposide (TP/TE), where paclitaxel was substituted with nab-paclitaxel due to anaphylaxis, followed by hysterectomy. One of the four initial complete hCG responders relapsed in the lung requiring further systemic treatment with subsequent lobectomy. Patient reported outcomes indicate persistent neurological symptoms are mild and do not affect functionality and quality of life.
With a follow-up range of 2-6 years, all five patients remain cured demonstrating excellent survival outcomes with the avoidance of whole-brain radiotherapy in all cases.
摘要：
目的：妊娠滋养细胞瘤（GTN）是一组罕见的恶性胎盘相关肿瘤，需要全身抗癌治疗。与GTN相关的脑膜疾病（LMD）没有很好的报道，在最佳治疗方面没有共识。我们为这些患者的管理提供建议。
方法：我们讨论了5例GTN患者，这些患者具有LMD的特征，并被诊断为g增强MRI脑，所有患者均接受低剂量诱导依托泊苷-顺铂（EP），然后再接受EP-依托泊苷，甲氨蝶呤（CNS）和放线菌素D（EMA）或EMA（CNS）-环磷酰胺和长春新碱（CO）。
结果：5例患者中有4例接受鞘内注射甲氨蝶呤。4例患者对一线多药化疗有完全的hCG反应，一名患者需要二线紫杉醇，顺铂与紫杉醇交替，依托泊苷（TP/TE），由于过敏反应，紫杉醇被nab-紫杉醇取代，其次是子宫切除术。四个最初的完全hCG应答者之一在肺部复发，需要进一步的全身治疗，随后进行肺叶切除术。患者报告的结果表明持续的神经系统症状是轻度的并且不影响功能和生活质量。
结论：随访2-6年，所有5例患者均保持治愈,在所有病例中避免全脑放疗,均显示优异的生存结局.
方法：我们讨论了5例GTN患者，这些患者具有LMD的特征，并被诊断为g增强MRI脑，所有患者均接受低剂量诱导依托泊苷-顺铂（EP），然后再接受EP-依托泊苷，甲氨蝶呤（CNS）和放线菌素D（EMA）或EMA（CNS）-环磷酰胺和长春新碱（CO）。
结果：5例患者中有4例接受鞘内注射甲氨蝶呤。4例患者对一线多药化疗有完全的hCG反应，一名患者需要二线紫杉醇，顺铂与紫杉醇交替，依托泊苷（TP/TE），由于过敏反应，紫杉醇被nab-紫杉醇取代，其次是子宫切除术。四个最初的完全hCG应答者之一在肺部复发，需要进一步的全身治疗，随后进行肺叶切除术。患者报告的结果表明持续的神经系统症状是轻度的并且不影响功能和生活质量。
结论：随访2-6年，所有5例患者均保持治愈,在所有病例中避免全脑放疗,均显示优异的生存结局.
