Stereotactic Radiosurgery for Choriocarcinoma Brain Metastases: Illustrative Case Presentation and Systematic Review

Background: Choriocarcinoma (CC) is a rare and aggressive form of germ cell tumor. There is limited evidence describing clinical outcomes in patients with primary CC and brain metastases (BM). Only a few single case reports have documented the use of stereotactic radiosurgery (SRS) for CC BM.

Methods: We retrospectively assessed patients who were treated with SRS for pure CC BM from 1998 to 2024. Lesion follow-up sizes and local tumor control status were evaluated after SRS treatment using response evaluation criteria in solid tumors criteria. A comprehensive literature search was performed for CC BM in accordance with PRISMA guidelines.

Results: In our series, 3 patients with 7 CC BM underwent SRS. Two were male with testicular CC and one was female with gestational CC. The median diameter of the lesions was 8 mm, with a median volume of 0.14 cm³ at treatment. Magnetic resonance imaging at 3 and 6 months showed reductions in median diameters to 6 mm and 4 mm, respectively. At the last follow-up visits, one lesion had local progression at 15 months after SRS and 1 lesion had sustained complete response. The systematic review yielded 249 articles. After screening, 18 reports were identified for CC BM. Among these reports, only 3 single case reports document outcomes of SRS for CC BM.

Conclusions: SRS is a feasible and viable approach for CC BM, particularly in cases where immediate surgical management is not necessary. This is the largest report to date evaluating the outcome of CC BM treated with SRS.