1
|
Cabitza E, Pirola M, Baldessari C, Bernardelli G, Zunarelli E, Pipitone S, Vitale MG, Nasso C, Molinaro E, Oltrecolli M, D'Agostino E, Mandato VD, Palicelli A, Dominici M, Sabbatini R. Cerebellar metastasis of ovarian cancer: a case report. J Med Case Rep 2023; 17:553. [PMID: 38115068 PMCID: PMC10731881 DOI: 10.1186/s13256-023-04211-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 10/12/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Ovarian cancer is metastatic at presentation in about 62% of cases, but brain metastases are rare, reported in 3.3-4% of patients. Brain metastasis seems to be more frequent in advanced stages at diagnosis and in patients with BRCA1/2 mutation. CASE PRESENTATION We present a case of a 47-year-old Caucasian woman, BRCA wild type, with an ovarian cancer that started with single cerebellar metastasis. CONCLUSION Brain metastases in ovarian cancer are rare and complex for diagnosis and management. This case focuses both on diagnosis and treatment, emphasizing the importance of a multimodal approach in a multidisciplinary team.
Collapse
Affiliation(s)
- Eleonora Cabitza
- Oncology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Marta Pirola
- Oncology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy.
| | - Cinzia Baldessari
- Oncology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | | | - Elena Zunarelli
- Anatomic Pathology Unit, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Stefania Pipitone
- Oncology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | | | | | | | - Marco Oltrecolli
- Oncology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Elisa D'Agostino
- Oncology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | | | - Andrea Palicelli
- Pathology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Dominici
- Oncology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Roberto Sabbatini
- Oncology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| |
Collapse
|
2
|
Zhang Z, Xu M, Sakandar A, Du X, He H, He W, Li D, Wen Q. Successful Treatment of a Patient With Brain Metastasis From Ovarian Cancer With BRCA Wild Type Using Niraparib: A Case Report and Review of the Literature. Front Oncol 2022; 12:873198. [PMID: 35574424 PMCID: PMC9098951 DOI: 10.3389/fonc.2022.873198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundBrain metastases from ovarian cancer are extremely rare and have a very poor prognosis. A multimodal approach (surgery combined with radiotherapy and chemotherapy) yields the best results in reducing neurological symptoms and prolonging survival. Unfortunately, not every patient receives a complete multimodal treatment due to their individual factors. Poly(ADP-ribose) polymerase (PARP) inhibitors have emerged as a maintenance treatment option for recurrent ovarian cancer. Using PARPi may prolong the overall survival in patients with brain metastases and recurrent ovarian cancer.Case PresentationWe report a case of a female patient with advanced ovarian cancer without any germline or somatic BRCA mutation. After 21 months, after reduction surgery and adjuvant chemotherapy, she was diagnosed with brain metastasis. Due to her physical fitness and economic situation, she did not receive any radiotherapy or chemotherapy but only received surgical debulking of the brain metastasis and niraparib maintenance treatment. Up to now, she has achieved a good treatment response, and the PFS is 29 months.ConclusionBased on the response of our patient, PARP inhibitors as a single agent can probably be considered in patients with brain metastasis from ovarian cancer without BRCA mutation who cannot tolerate radiotherapy and chemotherapy.
Collapse
|
3
|
Bahat Z, Cakmak VA, Cakir E. Brain metastasis from ovarian carcinoma: Analysis of eight cases from a single radiotherapy center. Taiwan J Obstet Gynecol 2021; 59:711-717. [PMID: 32917323 DOI: 10.1016/j.tjog.2020.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Brain metastasis from epithelial ovarian carcinoma (EOC) is rarely seen having rate of 1-3% with very poor prognosis. Studies on brain metastatic EOC is limited with low number of participants. An increasing trend in EOC related to brain metastasis has been reported recently confronting managing clinicians with new challenges. Therefore, more information on this issue is needed. We aimed to analyze a single radiotherapy center experience on EOC related brain metastases. MATERIALS AND METHODS Data of all patients treated between January 1998 and December 2016 at a radiation center of a university hospital were reviewed retrospectively. Clinicopathological characteristics, treatment details and outcome were analyzed. RESULTS We identified only ten cases with EOC related brain metastasis in our department during 18-year period. Two patients were excluded because of data unavailability and therefore our study was performed among 8 patients. The median time between EOC diagnosis and detection of brain metastasis was 19.8 months. Brain metastasis was multiple in majority (75%). Extracranial metastasis at the time of brain metastasis was 62.5%. All patients died in the follow-up. The median survival time after the diagnosis of brain metastasis was 4.5 months. The median overall survival (OS) after the diagnosis of EOC was 28.9 months. The interval between the initial diagnosis and brain metastasis was negatively correlated with survival after brain metastasis (B-OS) occurred as time interval (p = 0.047). Presence of extracranial metastasis at time of occurrence of brain metastasis and application of multimodal treatment after brain metastasis were positively correlated with B-OS time (p = 0.007, p = 0.046, respectively). CONCLUSION Prognosis of brain metastasis from EOC remains poor. The factors associated with better B-OS were the longer time between initial diagnosis and brain metastasis, absence of extracranial disease at time of brain metastasis, and application of the multimodal treatment.
Collapse
Affiliation(s)
- Zumrut Bahat
- Karadeniz Technical University, Faculty of Medicine, Department of Radiation Oncology, Trabzon, Turkey.
| | | | - Ertugrul Cakir
- Karadeniz Technical University, Faculty of Medicine, Department of Neurosurgery, Trabzon, Turkey
| |
Collapse
|
4
|
Abstract
OBJECTIVE The objective of this study was to investigate the prevalence, clinicopathologic characteristics, management, and outcomes of patients with brain metastasis (BM) from gynecologic malignancies in a large hospital-based database. MATERIALS AND METHODS The National Cancer Database (NCDB) was accessed and patients with ovarian, uterine, or cervical cancer and BM were identified. We identified those who received radiation therapy (RT) as whole-brain radiation therapy (WBRT) or stereotactic radiosurgery (SRS). Kaplan-Meier curves were generated to determine median overall survival (OS) and compared with the log-rank test. RESULTS A total of 853 patients with BM were identified. The rate of BMs upon diagnosis was 0.4% (211/57,160) for patients with cervical cancer, 0.2% (498/243,785) for patients with uterine, and 0.2% (144/92,301) for ovarian malignancies. Only 30.4% had isolated BM, while 52.2% had lung metastasis. Approximately half of the patients (50.1%) received chemotherapy, while brain RT was administered to 324 (38%) patients. Among patients who received brain RT, only 60 (18.5%) had SRS, while 264 (81.5%) had WBRT. Patients who underwent SRS had a better survival (n=47, median OS=9 mo) than those who received WBRT (n=201, median OS=4.73 mo, P=0.018), or those who did not receive any brain RT (n=370, median OS=4.01 mo, P=0.007). CONCLUSIONS The incidence of BM among patients with gynecologic malignancies is rare and associated with poor survival. For select patients, SRS may be associated with prolonged survival.
Collapse
|
5
|
Wohl A, Kimchi G, Korach J, Perri T, Zach L, Zibly Z, Harel R, Nissim U, Spiegelmann R, Nass D, Cohen ZR. Brain Metastases from Ovarian Carcinoma: An Evaluation of Prognostic Factors and Treatment. Neurol India 2020; 67:1431-1436. [PMID: 31857529 DOI: 10.4103/0028-3886.273627] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aims and Objectives To review a series of patients with brain metastases from ovarian cancer at a single institution. To describe treatment modalities, their outcomes and to determine prognostic factors. Patients and Methods Between January 1995 and December 2014, 25 patients with ovarian cancer brain metastases were treated at The Sheba Medical Center. The medical records were retrospectively reviewed to collect demographic, clinical, and imaging data as well as the information on the treatment modalities used and their outcomes. Results Mean patient age at the time of brain metastasis diagnosis was 62.7 years. The median interval between the diagnosis of primary cancer and brain metastasis was 42.3 months. Neurologic deficits, headache, and seizure were the most common symptoms. The brain was the only site of metastasis in 20% of the patients. Active ovarian cancer at the time of diagnosis of brain metastasis was observed in half of the patients with systemic disease. Multiple brain metastases were observed in 25% of the patients. We treated 11 patients with surgery plus radiation therapy protocols in various orders: surgery followed by complementary whole-brain radiation therapy (WBRT), surgery followed by stereotactic radiosurgery (SRS), and surgery followed by WBRT and then by adjuvant SRS. Five patients underwent surgery alone and nine patients were treated with radiation alone (WBRT, SRS, or both). Univariate analysis for predictors of survival demonstrated that age above 62.7 years at the time of central nervous system involvement was a significant risk factor and leptomeningeal disease was a poor prognostic factor in reference to supra-tentorial lesions. Multivariate analysis for predictors of survival, however, showed that multiple brain lesions (>4) were a poor prognostic factor, and multivariate analysis of the time to progression revealed that combined treatments of surgery and radiation resulted in longer median periods of progression-free survival than each modality alone. Conclusion We conclude that the only significant predictors of survival or progression-free survival in our cohort were the number of brain metastases and the treatment modality.
Collapse
Affiliation(s)
- Anton Wohl
- Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel
| | - Gil Kimchi
- Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel
| | - Jacob Korach
- Department of Gynecology, Sheba Medical Center, Ramat Gan, Israel
| | - Tamar Perri
- Department of Gynecology, Sheba Medical Center, Ramat Gan, Israel
| | - Leor Zach
- Department of Oncology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv, Israel
| | - Zion Zibly
- Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel
| | - Ran Harel
- Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel
| | - Uzi Nissim
- Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel
| | | | - Dvora Nass
- Department of Pathology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv, Israel
| | - Zvi R Cohen
- Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel
| |
Collapse
|
6
|
da Costa AABA, Dos Santos ES, Cotrim DP, Pandolfi NC, Cesca MG, Mantoan H, Sanches SM, Ribeiro ARG, de Brot L, Bonvolim G, Sanematsu PI, de Souza RP, Maya JML, de Souza Castro F, da Nogueira Silveira Lima JP, Chen MJ, Guimarães APG, Baiocchi G. Prognostic impact of platinum sensitivity in ovarian carcinoma patients with brain metastasis. BMC Cancer 2019; 19:1194. [PMID: 31805898 PMCID: PMC6896587 DOI: 10.1186/s12885-019-6382-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 11/20/2019] [Indexed: 01/28/2023] Open
Abstract
Background Brain metastasis (BM) is a rare event in ovarian cancer patients. The current prognostic scores that have been used for other tumors do not account for specific characteristics of ovarian cancer, such as platinum sensitivity. Methods This retrospective cohort study examined patients with ovarian carcinoma and BM who were treated at a single institution from January 2007 to December 2017. Clinical data on the diagnosis of BM and follow-up were collected. Cox regression was used to evaluate prognostic factors for overall survival (OS). Results Of 560 patients, 26 presented with BM. Eight patients were treated with surgery, 15 with whole-brain radiotherapy (RT), and 5 with stereotactic RT, and 4 patients received systemic treatment at the diagnosis of BM. The median OS was 10.8 months. The following factors were associated with OS: platinum-sensitive recurrence (HR 0.34, 95% CI 0.12–0.99; p = 0.049), higher number of previous treatment lines (HR 1.57, 95% CI 1.12–2.19; p = 0.008), ECOG performance status (HR 2.52, 95% CI 1.24–5.09; p = 0.010), and longer interval from initial diagnosis to BM (p = 0.025). Notably, the number of brain metastasis, the largest tumor size, and progression outside of the CNS were not related to survival. Platinum sensitivity was not associated with any of the classic prognostic factors in brain metastasis patients such as number or size of brain metastasis or disease progression outside the CNS strengthening the hypothesis of the importance of platinum sensitivity to the prognosis of ovarian cancer patients with BM. Conclusions The factors related to the biological behavior of the ovarian cancer such as platinum sensitivity at the time of BM diagnosis, fewer number of previous treatment lines and interval from initial diagnosis were associated with survival in ovarian cancer patients with BM, while factors that are usually related to survival in BM in other cancers were not associated with survival in this cohort of ovarian cancer patients. The small number of patients did not allow us to exclude the prognostic role of these former factors that were not associated with survival in the present cohort.
Collapse
Affiliation(s)
| | - Elizabeth Santana Dos Santos
- Medical Oncology Department, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, São Paulo, SP, 01509-900, Brazil
| | - Deborah Porto Cotrim
- Medical Oncology Department, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, São Paulo, SP, 01509-900, Brazil
| | - Natasha Carvalho Pandolfi
- Medical Oncology Department, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, São Paulo, SP, 01509-900, Brazil
| | - Marcelle Goldner Cesca
- Medical Oncology Department, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, São Paulo, SP, 01509-900, Brazil
| | - Henrique Mantoan
- Gynecology Oncology Department, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, São Paulo, SP, 01509-900, Brazil
| | - Solange Moraes Sanches
- Medical Oncology Department, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, São Paulo, SP, 01509-900, Brazil
| | - Adriana Regina Gonçalves Ribeiro
- Medical Oncology Department, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, São Paulo, SP, 01509-900, Brazil
| | - Louise de Brot
- Pathology Department, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, São Paulo, SP, 01509-900, Brazil
| | - Graziele Bonvolim
- Pathology Department, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, São Paulo, SP, 01509-900, Brazil
| | - Paulo Issamu Sanematsu
- Neurosurgery Department, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, São Paulo, SP, 01509-900, Brazil
| | - Ronaldo Pereira de Souza
- Medical Oncology Department, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, São Paulo, SP, 01509-900, Brazil
| | - Joyce Maria Lisboa Maya
- Medical Oncology Department, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, São Paulo, SP, 01509-900, Brazil
| | - Fabrício de Souza Castro
- Medical Oncology Department, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, São Paulo, SP, 01509-900, Brazil
| | | | - Michael Jenwel Chen
- Radiotherapy Department, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, São Paulo, SP, 01509-900, Brazil
| | - Andrea Paiva Gadelha Guimarães
- Medical Oncology Department, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, São Paulo, SP, 01509-900, Brazil
| | - Glauco Baiocchi
- Gynecology Oncology Department, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, São Paulo, SP, 01509-900, Brazil
| |
Collapse
|
7
|
Long-Term Survival After Surgery and Radiotherapy for Recurrent or Persistent Ovarian and Tubal Cancer. Int J Gynecol Cancer 2019; 28:1090-1100. [PMID: 29846300 DOI: 10.1097/igc.0000000000001294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study examines the factors associated with long-term disease-specific survival (DSS) and complications after radiotherapy (RT) for recurrent or persistent ovarian and tubal cancer. METHODS/MATERIALS Between 1980 and 2015, 65 women with ovarian (57), tubal (3), or co-existent ovarian/endometrial carcinoma (5) received RT (>45 Gy) with curative intent for recurrent (45) or persistent cancer (20) found at second-look surgery. Surgery to debulk (± restage) was integrated into the management of all but 7 cases. RESULTS Twenty-two women had no evidence of disease at last contact after a median of 15.6 years (range = 1.0-35.8 years). Of the 53 patients treated more than 10 years ago, 18 (34%) are in this long-term no evidence of disease group. Univariate analysis showed that the following factors were significantly associated with longer DSS (P < 0.05): initial stage I, II (vs III, IV); endometrioid histology (vs serous and other); no or 1 previous chemotherapy (vs ≥2); no macroscopic tumor before RT (vs macroscopic); localized tumor encompassed by a limited-volume RT field (vs more widespread tumor), and chemotherapy and RT (vs RT only). Multivariate analysis showed that endometrioid (vs other histology HR = 4.37, P = 0.017) and localized tumor (vs more widespread tumor, HR = 2.43, P = 0.017) were significantly associated with longer DSS.After RT to the pelvis and/or abdomen, 13 (21.7%) of 60 patients developed G3 or 4 bowel complications requiring surgery. In 10, these occurred in the presence of tumor, RT changes, and adhesions, and in 3, there was no sign of cancer. Six patients (9.2%) developed a subsequent malignancy. CONCLUSIONS We conclude that there is a role for the use of RT in selected cases of localized recurrent or persistent ovarian cancer and may confer long-term survival. Surgery is useful to debulk and define the extent of tumor to be irradiated but may confer an increased risk of severe bowel complications.
Collapse
|
8
|
Takeshita S, Todo Y, Furuta Y, Okamoto K, Minobe S, Yamashiro K, Kato H. Prognostic factors for patients with brain metastasis from gynecological cancer: a significance of treatment-free interval of more than 6 months. Jpn J Clin Oncol 2017; 47:604-610. [PMID: 28398498 DOI: 10.1093/jjco/hyx047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/21/2017] [Indexed: 11/14/2022] Open
Abstract
Objective Treatment-free interval has been confirmed as a significant prognostic factor in recurrent gynecological cancers. However, treatment-free interval has not been evaluated in previous studies investigating brain metastasis from gynecological malignancies. The aim of the study was to establish a predictive model of survival period after brain metastasis from gynecological cancer. Methods Of a total of 2848 patients with gynecological cancer, patients with brain metastasis were included in the study. Data at the time of brain metastasis diagnosis, which included primary origin, presence of extracranial metastasis, the Eastern Cooperative Oncology Group (ECOG) performance status, the number of brain metastases, brain-metastasis free-interval, treatment-free interval and treatment for brain metastasis were collected. Survival data were analyzed using Kaplan-Meier methods and Cox proportional hazards models. Results Incidences of brain metastasis were 1.7% (47/2848). Median survival period after diagnosis of brain metastasis was 20 weeks (4-5 months). The 6-, 12- and 24-month survival rates after brain metastasis were 44.0%, 22.0% and 16.5%, respectively. Cox regression analysis showed that extracranial metastasis (hazard ratio [HR], 5.2; 95% confidence interval [CI]: 1.04-26.3), ECOG performance status of 3-4 (HR, 3.1; 95% CI: 1.20-7.91), treatment-free interval of <6 months (HR, 3.8; 95% CI: 1.09-13.1), and no anti-cancer treatment for brain metastasis (HR, 3.6; 95% CI: 1.34-9.41) were significantly and independently related to poor survival. Conclusion Treatment-free interval should be assessed in a future study to verify prognostic predictors of brain metastasis from gynecological cancer.
Collapse
Affiliation(s)
- Sho Takeshita
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center
| | - Yukiharu Todo
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center
| | - Yu Furuta
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center
| | - Kazuhira Okamoto
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center
| | - Shinichiro Minobe
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center
| | - Katsushige Yamashiro
- Division of Pathology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan
| | - Hidenori Kato
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center
| |
Collapse
|
9
|
Kim SB, Hwang K, Joo JD, Han JH, Kim YB, Kim CY. Outcomes in 20 Gynecologic Cancer Patient with Brain Metastasis: A Single Institution Retrospective Study. Brain Tumor Res Treat 2017; 5:87-93. [PMID: 29188209 PMCID: PMC5700032 DOI: 10.14791/btrt.2017.5.2.87] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/15/2017] [Accepted: 10/16/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The incidence of brain metastasis (BM) in gynecologic cancers has risen recently, due to prolonged survival times and an early diagnosis. We analyzed treatment outcomes of patients with BM from gynecologic cancers. METHODS Among 951 patients with BM who were treated in neurosurgical department from July 2003 to February 2016, a total of 20 (2%) patients were from gynecologic cancers. The patients' clinical characteristics were collected by using medical records. There were 14 (66.7%) ovarian cancers, 4 (19.0%) uterine cancers, and 2 (9.5%) cervical cancers. As a primary treatment modality, 11 patients were treated with Gamma Knife surgery (GKS), 6 with surgical resection followed by whole brain radiation therapy (WBRT), and 3 with WBRT only. Overall and progression-free survival according to the primary origin and the primary treatment were analyzed. RESULTS Median overall survival time was 28 months, and progression-free survival was 15 months. In patients with ovarian cancer, median overall survival did not reach during the follow-up periods and progression-free survival time was 15 months. Median overall survival time in patients who received GKS as the primary treatment was 17 months and that in patients who underwent surgical resection followed by WBRT was 37.3 months (p=0.16). The median value of progression-free survival time in patients who received GKS as the primary treatment was 12 months and that in patients who underwent surgical resection with WBRT was 42 months (p=0.042). Median follow up period of over all patients was 13 months. CONCLUSION BM from gynecologic cancer is rare (2%), but our findings suggest that the prognosis might not always be poor. In our small series, surgical resection with WBRT was a treatment modality significantly associated with a longer progression-free survival. Additional studies with more cases and multi-institutional cooperation are needed to determine which treatment modality leads to better outcomes.
Collapse
Affiliation(s)
- Seung Bin Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kihwan Hwang
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin-Deok Joo
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Ho Han
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Beom Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Chae-Yong Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
10
|
Marchetti C, Ferrandina G, Cormio G, Gambino A, Cecere S, Lorusso D, De Giorgi U, Bogliolo S, Fagotti A, Mammoliti S, Narducci F, Bergamini A, Scollo P, Biglia N, Breda E, Tamberi S, Marinaccio M, Angioli R, Salerno L, Eusebi MC, Loizzi V, Scambia G, Panici PB. Brain metastases in patients with EOC: Clinico-pathological and prognostic factors. A multicentric retrospective analysis from the MITO group (MITO 19). Gynecol Oncol 2016; 143:532-538. [PMID: 27717490 DOI: 10.1016/j.ygyno.2016.09.025] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/24/2016] [Accepted: 09/27/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Brain metastases (BM) from epithelial ovarian cancer (EOC) are considered a rare and unfavourable event. There is no consensus regarding the best management of these patients. METHODS A multicenter retrospective analysis of patients with BM from EOC treated between 1997 and 2014 in 18 institutions of the MITO (Multicenter Italian Trials in Ovarian cancer) group was conducted. Univariate and multivariate analysis were performed. RESULTS A total of 174 women were identified as having BM from EOC. The median time interval between primary diagnosis of EOC and occurrence of BM was 26months (range 2-129months). The median overall survival from primary EOC diagnosis was 48months (95% CI 39.5-56.4months) and from diagnosis of BM was 12months (95% CI 9.6-14.3months). The majority of enrolled women (81.7%) were classified as sensitive to platinum-based chemotherapy. Four variables were significantly associated with poor overall survival in multivariate analysis: multiple BM [HR: 1.86 (95% CI: 1.22-2.84)], presence of extracranial disease [HR: 1.77 (95% CI: 1.11-2.83)] age [HR: 1.74 (95% CI: 1.17-2.59)], and monotherapy [HR: 2.57 (95% CI: 1.64-3.86)]. On the contrary, residual tumor at primary surgery, FIGO stage at primary diagnosis and platinum sensitivity were found to have no significant impact on survival from diagnosis of brain lesions. CONCLUSIONS Our results suggest that BM is a rare and late manifestation of EOC, with a 12-month life-span expectation. Multiple approach is a positive independent prognostic factor and should be proposed to carefully selected patients.
Collapse
Affiliation(s)
- Claudia Marchetti
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, University of Rome "Sapienza" Rome, Italy.
| | - Gabriella Ferrandina
- Department of Medicine and Health Science, University of Molise/Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy
| | - Gennaro Cormio
- Gynecologic Oncology Unit, University of Bari and Oncology Institute "Giovanni Paolo II", Bari, Italy
| | - Angela Gambino
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Sabrina Cecere
- Department of Gynecologic and Urologic Oncology, Fondazione Pascale, National Cancer Institute of Naples, Italy
| | - Domenica Lorusso
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy
| | - Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Stefano Bogliolo
- Department of Obstetrics and Gynecology, University Research Hospital "Fondazione IRCCS Policlinico San Matteo" of Pavia, Italy
| | - Anna Fagotti
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy; Gynecologic Oncology, S. Maria Hospital, University of Perugia, Terni, Italy
| | | | | | - Alice Bergamini
- Department of Obstetrics and Gynecology, San Raffaele Hospital, Milan, Italy
| | - Paolo Scollo
- Department of Obstetrics and Gynecology, Hospital Cannizzaro, Catania, Italy
| | - Nicoletta Biglia
- Department of Obstetrics and Gynecology, University of Torino School of Medicine, Torino, Italy
| | - Enrico Breda
- Hospital S. Giovanni Calibita Fatebenefratelli Isola Tiberina, Roma, Italy
| | | | - Marco Marinaccio
- Department of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Roberto Angioli
- Department of Obstetrics and Gynaecology Campus Bio Medico University of Rome, 00128 Rome, Italy
| | - Laura Salerno
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, University of Rome "Sapienza" Rome, Italy
| | - Maria Chiara Eusebi
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Vera Loizzi
- Gynecologic Oncology Unit, University of Bari and Oncology Institute "Giovanni Paolo II", Bari, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, University of Rome "Sapienza" Rome, Italy
| |
Collapse
|
11
|
Gilani MA, Williams NL, Giordano C, Rosenblum N, Shi W, Anne P, Schilder RJ. Brain Metastases in Patients with Gynecologic Cancers: A Single Institution Experience and Review of the Literature. ACTA ACUST UNITED AC 2016; 6:544-552. [PMID: 31552146 PMCID: PMC6758932 DOI: 10.4236/ojog.2016.69070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objective: Brain Metastasis (BM) from primary gynecologic cancers is a rare entity. The advances and successes in the treatment of primary gynecologic malignancies, have led to prolonged survival and, a higher incidence of BM. This study aims to report the experience at our institution in managing these patients, and provide possible data points that may be essential to note as prognostic factors, and see if our findings are consistent with the literature in this subject. We also aim to provide a brief literature review of patients with gynecologic cancers and BM. Methods: This is a small single institution retrospective study of 23 patients with a gynecologic malignancy and BM, identified between the years 2007–2015. Data were collected on variables including patient demographics, disease and treatment. Results: The median overall survival from the primary diagnosis was 28 months. Median time from diagnosis of BM to death was 9 months. Conclusion: The outcomes in our study are similar to what is stated in the current literature with regard to BM from gynecologic malignancies. Our literature search also revealed that the molecular analysis and treatment of the primary tumor remain important to prevent BMs. The tendency of tumors to metastasize varies for one tumor type to another for the same type of tumor. The tendency to develop BM may not only depend on risk factors such as stage, grade, and histology, but also on the genetic profile of the primary tumor. The study suggests that multimodal treatment of BM has better outcomes in managing BM from gynecologic cancers.
Collapse
Affiliation(s)
| | - Noelle L Williams
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Carolyn Giordano
- Office of Institutional Research, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Wenyin Shi
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Pramila Anne
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Russell J Schilder
- Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| |
Collapse
|
12
|
Surgical management of lung, liver and brain metastases from gynecological cancers: a literature review. GYNECOLOGIC ONCOLOGY RESEARCH AND PRACTICE 2016; 3:7. [PMID: 27330821 PMCID: PMC4912748 DOI: 10.1186/s40661-016-0028-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/03/2016] [Indexed: 12/28/2022]
Abstract
Background The management of patients with recurrent gynecological malignancy is complex, and often contentious. While historically, patients with metastases in the lungs, liver or brain have been treated with palliative intent, surgery is proving to have an increasing role in the management of such patients. Methods In this review article, the surgical management of lung, liver and brain metastases from gynecological cancers is examined. A search of the English language literature over the last 25 years was conducted using the Medline and PubMed databases. Results The results for management of metastases from the endometrium, ovary and cervix to the lung, brain and liver show that surprisingly good long-term survival results can be achieved for resection of metastases from all three organs. Patient selection is critical, and surgery is often used in conjunction with other treatment modalities. Conclusions From this review, it is apparent that surgery should play an increasing role in the management of patients with parenchymal metastases from gynecological cancers. The surgery should ideally be performed in high volume, tertiary centers where there is a committed multi-disciplinary team with the necessary infrastructure to achieve the best possible outcomes in terms of both survival and morbidity.
Collapse
|
13
|
Divine LM, Kizer NT, Hagemann AR, Pittman ME, Chen L, Powell MA, Mutch DG, Rader JS, Thaker PH. Clinicopathologic characteristics and survival of patients with gynecologic malignancies metastatic to the brain. Gynecol Oncol 2016; 142:76-82. [PMID: 27117923 DOI: 10.1016/j.ygyno.2016.04.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 04/02/2016] [Accepted: 04/22/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE No standardized treatment strategies exist for patients with gynecologic malignancies complicated by brain metastases. Identification of poor outcome characteristics, long-term survival indicators, and molecular markers could help individualize and optimize treatment. METHODS This retrospective cohort study included 100 gynecologic cancer patients with brain metastases treated at our institution between January 1990 and June 2009. Primary outcome was overall survival (OS) from time of diagnosis of brain metastases. We used univariate and multivariate analyses to evaluate associations between OS and clinical factors. We used immunohistochemistry to examine expression of five molecular markers in primary tumors and brain metastases in a subset of patients and matched controls. Statistical tests included the Student's paired t-test (for marker expression) and Kaplan-Meier test (for correlations). RESULTS On univariate analysis, primary ovarian disease, CA-125<81units/mL at brain metastases diagnosis, and isolated versus multi-focal metastases were all associated with longer survival. Isolated brain metastasis remained the only significant predictor on multivariate analysis (HR 2.66; CI 1.19-5.93; p=0.017). Expression of vascular endothelial growth factor A (VEGF-A) was higher in metastatic brain samples than in primary tumors of controls (p<0.0001). None of the molecular markers were significantly associated with survival. CONCLUSIONS Multi-modality therapy may lead to improved clinical outcomes, and VEGF therapy should be investigated in treatment of brain metastases.
Collapse
Affiliation(s)
- Laura M Divine
- Washington University School of Medicine & Alvin J. Siteman Cancer Center, St. Louis, MO, United States
| | - Nora T Kizer
- Department of Obstetrics and Gynecology, Springfield Clinic, Springfield, IL, Division of Gynecologic Oncology, United States
| | - Andrea R Hagemann
- Washington University School of Medicine & Alvin J. Siteman Cancer Center, St. Louis, MO, United States
| | - Meredith E Pittman
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, United States
| | - Ling Chen
- Division of Biostatistics, Washington University School of Medicine, Alvin J. Siteman Cancer Center, Saint Louis, MO, United States
| | - Matthew A Powell
- Washington University School of Medicine & Alvin J. Siteman Cancer Center, St. Louis, MO, United States
| | - David G Mutch
- Washington University School of Medicine & Alvin J. Siteman Cancer Center, St. Louis, MO, United States
| | - Janet S Rader
- Division of Gynecologic Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Premal H Thaker
- Washington University School of Medicine & Alvin J. Siteman Cancer Center, St. Louis, MO, United States.
| |
Collapse
|
14
|
Kim YZ, Kwon JH, Lim S. A clinical analysis of brain metastasis in gynecologic cancer: a retrospective multi-institute analysis. J Korean Med Sci 2015; 30:66-73. [PMID: 25552885 PMCID: PMC4278029 DOI: 10.3346/jkms.2015.30.1.66] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 08/21/2014] [Indexed: 01/03/2023] Open
Abstract
This study analyzes the clinical characteristics of the brain metastasis (BM) of gynecologic cancer based on the type of cancer. In addition, the study examines the factors influencing the survival. Total 61 BM patients of gynecologic cancer were analyzed retrospectively from January 2000 to December 2012 in terms of clinical and radiological characteristics by using medical and radiological records from three university hospitals. There were 19 (31.1%) uterine cancers, 32 (52.5%) ovarian cancers, and 10 (16.4%) cervical cancers. The mean interval to BM was 25.4 months (21.6 months in ovarian cancer, 27.8 months in uterine cancer, and 33.1 months in cervical cancer). The mean survival from BM was 16.7 months (14.1 months in ovarian cancer, 23.3 months in uterine cancer, and 8.8 months in cervical cancer). According to a multivariate analysis of factors influencing survival, type of primary cancer, Karnofsky performance score, status of primary cancer, recursive partitioning analysis class, and treatment modality, particularly combined therapies, were significantly related to the overall survival. These results suggest that, in addition to traditional prognostic factors in BM, multiple treatment methods such as neurosurgery and combined chemoradiotherapy may play an important role in prolonging the survival for BM patients of gynecologic cancer.
Collapse
Affiliation(s)
- Young Zoon Kim
- Division of Neurooncology, Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jae Hyun Kwon
- Department of Neurosurgery, Dong-A University Medical Center, Dong-A University College of Medicine, Busan, Korea
| | - Soyi Lim
- Department of Obstetrics and Gynecology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| |
Collapse
|
15
|
Pakneshan S, Safarpour D, Tavassoli F, Jabbari B. Brain metastasis from ovarian cancer: a systematic review. J Neurooncol 2014; 119:1-6. [PMID: 24789253 DOI: 10.1007/s11060-014-1447-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 04/13/2014] [Indexed: 11/26/2022]
Abstract
To review the existing literature on brain metastasis (BM) from ovarian cancer and to assess the frequency, anatomical, clinical and paraclinical information and factors associated with prognosis. Ovarian cancer is a rare cause of brain metastasis with a recently reported increasing prevalence. Progressive neurologic disability and poor prognosis is common. A comprehensive review on this subject has not been published previously. This systematic literature search used the Pubmed and Yale library. A total of 66 publications were found, 57 of which were used representing 591 patients with BM from ovarian cancer. The median age of the patients was 54.3 years (range 20-81). A majority of patients (57.3 %) had multiple brain lesions. The location of the lesion was cerebellar (30 %), frontal (20 %), parietal (18 %) and occipital (11 %). Extracranial metastasis was present in 49.8 % of cases involving liver (20.7 %), lung (20.4 %), lymph nodes (12.6 %), bones (6.6 %) and pelvic organs (4.3 %). The most common symptoms were weakness (16 %), seizures (11 %), altered mentality (11 %) visual disturbances (9 %) and dizziness (8 %). The interval from diagnosis of breast cancer to BM ranged from 0 to 133 months (median 24 months) and median survival was 8.2 months. Local radiation, surgical resection, stereotactic radiosurgery and medical therapy were used. Factors that significantly increased the survival were younger age at the time of ovarian cancer diagnosis and brain metastasis diagnosis, lower grade of the primary tumor, higher KPS score and multimodality treatment for the brain metastases. Ovarian cancer is a rare cause of brain metastasis. Development of brain metastasis among older patients and lower KPS score correlate with less favorable prognosis. The more prolonged survival after using multimodality treatment for brain metastasis is important due to potential impact on management of brain metastasis in future.
Collapse
Affiliation(s)
- Shabnam Pakneshan
- Department of Neurology, Yale University School of Medicine, 15 York Street, LCI Building, New Haven, CT, 06520, USA,
| | | | | | | |
Collapse
|
16
|
Niu X, Rajanbabu A, Delisle M, Peng F, Vijaykumar DK, Pavithran K, Feng Y, Lau S, Gotlieb WH, Press JZ. Brain metastases in women with epithelial ovarian cancer: multimodal treatment including surgery or gamma-knife radiation is associated with prolonged survival. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 35:816-822. [PMID: 24099447 DOI: 10.1016/s1701-2163(15)30838-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To explore the impact of treatment modality on survival in patients with brain metastases from epithelial ovarian cancer. METHODS We conducted a retrospective review of cases of ovarian cancer with brain metastases treated at institutions in three countries (Canada, China, and India) and conducted a search for studies regarding brain metastases in ovarian cancer reporting survival related to treatment modality. Survival was analyzed according to treatment regimens involving (1) some form of surgical excision or gamma-knife radiation with or without other modalities, (2) other modalities without surgery or gamma-knife radiation, or (3) palliation only. RESULTS Twelve patients (mean age 56 years) with detailed treatment/outcome data were included; five were from China, four from Canada, and three from India. Median time from diagnosis of ovarian cancer to brain metastasis was 19 months (range 10 to 37 months), and overall median survival time from diagnosis of ovarian cancer was 38 months (13 to 82 months). Median survival time from diagnosis of brain metastasis was 17 months (1 to 45 months). Among patients who had multimodal treatment including gamma-knife radiotherapy or surgical excision, the median survival time after the identification of brain metastasis was 25.6 months, compared with 6.0 months in patients whose treatment did not include this type of focused localized modality (P = 0.006). Analysis of 20 studies also indicated that use of gamma-knife radiotherapy and excisional surgery in multi-modal treatment resulted in improved median survival interval (25 months vs. 6.0 months, P < 0.001). CONCLUSION In the subset of patients with brain metastases from ovarian cancer, prolonged survival may result from use of multidisciplinary therapy, particularly if metastases are amenable to localized treatments such as gamma-knife radiotherapy and surgical excision.
Collapse
Affiliation(s)
- Xiaoyu Niu
- Obstetric and Gynecologic Department, Sichuan University Huaxi Second Hospital, Sichuan Province, China
| | - Anupama Rajanbabu
- Surgical and Gynecologic Oncology, Amrita Vishwavidyapeetham, Kochi, Kerala, India
| | - Megan Delisle
- Division of Gynecologic Oncology, Jewish General Hospital/Segal Cancer Centre/McGill University, Montreal QC
| | - Feng Peng
- Oncology Department, Sichuan University Huaxi Hospital, Sichuan Province, China
| | | | - Keechilattu Pavithran
- Department of Medical Oncology, Amrita Institute of Medical Sciences, Amrita Vishwavidyapeetham, Kochi, Kerala, India
| | - Yukuan Feng
- Obstetric and Gynecologic Department, Sichuan University Huaxi Second Hospital, Sichuan Province, China
| | - Susie Lau
- Division of Gynecologic Oncology, Jewish General Hospital/Segal Cancer Centre/McGill University, Montreal QC
| | - Walter H Gotlieb
- Division of Gynecologic Oncology, Jewish General Hospital/Segal Cancer Centre/McGill University, Montreal QC
| | - Joshua Z Press
- Division of Gynecologic Oncology, Jewish General Hospital/Segal Cancer Centre/McGill University, Montreal QC
| |
Collapse
|
17
|
Nasu K, Satoh T, Nishio S, Nagai Y, Ito K, Otsuki T, Hongo A, Hirashima Y, Ogura T, Shimada M. Clinicopathologic features of brain metastases from gynecologic malignancies: a retrospective study of 139 cases (KCOG-G1001s trial). Gynecol Oncol 2012; 128:198-203. [PMID: 23142074 DOI: 10.1016/j.ygyno.2012.11.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 10/31/2012] [Accepted: 11/01/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Although brain metastases from gynecologic malignancies are rare, such cases have been gradually increasing in number. The aim of the present study was to evaluate the clinicopathologic features and prognostic factors of brain metastases from gynecologic malignancies. METHODS Retrospective analysis of 139 patients with brain metastases from gynecologic malignancies was carried out as a multi-institutional study. The clinicophathological data of the patients were collected from medical records. RESULTS Median survival time of the patients with brain metastases was 12.5 months for the ovarian cancer group, 6.2 months for the corpus cancer group, and 5.0 months for the cervical cancer group; two-year overall survival rates were 19.7%, 6.1%, and 4.8%, respectively. Multivariate analysis revealed ovarian/tubal/peritoneal origin, KPS >70, single brain metastasis, absence of extracranial disease, cranial surgery, cranial radiotherapy, and chemotherapy to be independent favorable prognostic factors associated with overall survival. CONCLUSION It is considered that aggressive multimodal therapy is warranted in the treatment of brain metastases from gynecologic malignancies in carefully selected patients. The present study may provide a platform for the discussion of management strategies in these rare clinical scenarios.
Collapse
Affiliation(s)
- Kaei Nasu
- Kansai Clinical Oncology Group, Osaka, Osaka 543-8555, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Current world literature. Curr Opin Oncol 2012; 24:756-68. [PMID: 23079785 DOI: 10.1097/cco.0b013e32835a4c91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
|
19
|
Piura E, Piura B. Brain metastases from ovarian carcinoma. ISRN ONCOLOGY 2011; 2011:527453. [PMID: 22191058 PMCID: PMC3236423 DOI: 10.5402/2011/527453] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 10/23/2011] [Indexed: 11/23/2022]
Abstract
This paper will focus on knowledge related to brain metastases from ovarian carcinoma. So far, less than 600 cases were documented in the literature with an incidence among ovarian carcinoma patients ranging from 0.29% to 11.6%. The ovarian carcinoma was usually an advanced-stage epithelial serous carcinoma, and the median interval between diagnosis of ovarian carcinoma and brain metastases was 2 years. Most often, brain metastases, affected the cerebrum, were multiple and part of a disseminated disease. Treatment of brain metastasis has evolved over the years from whole brain radiotherapy (WBRT) only to multimodal therapy including surgical resection or stereotactic radiosurgery followed by WBRT and/or chemotherapy. The median survival after diagnosis of brain metastases was 6 months; nevertheless, a significantly better survival was achieved with multimodal therapy compared to WBRT only. It is suggested that brain imaging studies should be included in the followup of patients after treatment for ovarian carcinoma.
Collapse
Affiliation(s)
- Ettie Piura
- Department of Obstetrics and Gynecology, Sapir Medical Center, Sackler School of Medicine, University of Tel-Aviv, Kfar-Saba 44281, Israel
| | - Benjamin Piura
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel
| |
Collapse
|