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Frezzini S, Tasca G, Borgato L, Sartor L, Ferrero A, Artioli G, Modena A, Baldoni A. PARP Inhibitors in Brain Metastases from Epithelial Ovarian Cancer through a Multimodal Patient Journey: Case Reports and Literature Review. Int J Mol Sci 2024; 25:7887. [PMID: 39063128 PMCID: PMC11276770 DOI: 10.3390/ijms25147887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Epithelial ovarian cancer (EOC) is the deadliest gynecological malignancy worldwide. Brain metastasis (BM) is quite an uncommon presentation. However, the likelihood of central nervous system (CNS) metastasization should be considered in the context of disseminated disease. The therapeutic management of BMs is an unmet clinical need, to date. We identified, across different cancer centers, six cases of both BRCA wild-type and BRCA-mutated EOCs spreading to the CNS. They presented either with a single brain lesion or with multiple lesions and most of them had intracranial-only disease. All cases received Poly-ADP ribose polymerase inhibitor (PARPi) maintenance, as per clinical practice, for a long time within a multimodal treatment approach. We also provide an insight into the available body of work regarding the management of this intriguing disease setting, with a glimpse of future therapeutic challenges. Despite the lack of unanimous guidelines, multimodal care pathways should be encouraged for the optimal disease control of this unfortunate patient subset. Albeit not being directly investigated in BM patients, PARPi maintenance is deemed to have a valuable role in this setting. Prospective research, aimed to implement worthwhile strategies in the multimodal patient journey of BMs from EOC, is eagerly awaited.
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Affiliation(s)
- Simona Frezzini
- Medical Oncology 3 Unit, Veneto Institute of Oncology IOV—IRCCS, 35128 Padova, Italy
| | - Giulia Tasca
- Medical Oncology 2 Unit, Veneto Institute of Oncology IOV—IRCCS, 35128 Padova, Italy;
| | - Lucia Borgato
- Medical Oncology Unit, Ospedale San Bortolo, 36100 Vicenza, Italy;
| | - Lucia Sartor
- Medical Oncology Unit, Ospedale di Camposampiero, ULSS 6 Euganea, 35131 Padova, Italy;
| | - Annamaria Ferrero
- Academic Department Gynecologic Oncology, Mauriziano Hospital, University of Torino, 10124 Torino, Italy;
| | - Grazia Artioli
- Medical Oncology Unit, Azienda ULSS 2 Marca Trevigiana, 31100 Treviso, Italy;
| | - Alessandra Modena
- Medical Oncology Department, IRCCS Ospedale Sacro Cuore Don Calabria, 37024 Negrar, Italy;
| | - Alessandra Baldoni
- Oncology and Hematology Department, Mirano AULSS3 Serenissima, 30035 Mirano, Italy;
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2
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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.
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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
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3
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Ly TTG, Yun J, Ha JS, Kim YJ, Jang WB, Van Le TH, Rethineswaran VK, Choi J, Kim JH, Min SH, Lee DH, Yang JS, Chung JS, Kwon SM. Inhibitory Effect of Etravirine, a Non-Nucleoside Reverse Transcriptase Inhibitor, via Anterior Gradient Protein 2 Homolog Degradation against Ovarian Cancer Metastasis. Int J Mol Sci 2022; 23:944. [PMID: 35055132 PMCID: PMC8777939 DOI: 10.3390/ijms23020944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 02/01/2023] Open
Abstract
Anterior gradient protein 2 homolog (AGR2), an endoplasmic reticulum protein, is secreted in the tumor microenvironment. AGR2 is a member of the disulfide isomerase family, is highly expressed in multiple cancers, and promotes cancer metastasis. In this study, we found that etravirine, which is a non-nucleoside reverse transcriptase inhibitor, could induce AGR2 degradation via autophagy. Moreover, etravirine diminished proliferation, migration, and invasion in vitro. Moreover, in an orthotopic xenograft mouse model, the combination of etravirine and paclitaxel significantly suppressed cancer progression and metastasis. This drug may be a promising therapeutic agent for the treatment of ovarian cancer.
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Affiliation(s)
- Thanh Truong Giang Ly
- Laboratory for Vascular Medicine and Stem Cell Biology, Department of Physiology, Medical Research Institute, School of Medicine, Pusan National University, Yangsan 50612, Korea; (T.T.G.L.); (J.Y.); (J.-S.H.); (Y.-J.K.); (W.-B.J.); (T.H.V.L.); (V.K.R.); (J.C.)
- Convergence Stem Cell Research Center, Pusan National University, Yangsan 50612, Korea;
| | - Jisoo Yun
- Laboratory for Vascular Medicine and Stem Cell Biology, Department of Physiology, Medical Research Institute, School of Medicine, Pusan National University, Yangsan 50612, Korea; (T.T.G.L.); (J.Y.); (J.-S.H.); (Y.-J.K.); (W.-B.J.); (T.H.V.L.); (V.K.R.); (J.C.)
- Convergence Stem Cell Research Center, Pusan National University, Yangsan 50612, Korea;
| | - Jong-Seong Ha
- Laboratory for Vascular Medicine and Stem Cell Biology, Department of Physiology, Medical Research Institute, School of Medicine, Pusan National University, Yangsan 50612, Korea; (T.T.G.L.); (J.Y.); (J.-S.H.); (Y.-J.K.); (W.-B.J.); (T.H.V.L.); (V.K.R.); (J.C.)
- Convergence Stem Cell Research Center, Pusan National University, Yangsan 50612, Korea;
| | - Yeon-Ju Kim
- Laboratory for Vascular Medicine and Stem Cell Biology, Department of Physiology, Medical Research Institute, School of Medicine, Pusan National University, Yangsan 50612, Korea; (T.T.G.L.); (J.Y.); (J.-S.H.); (Y.-J.K.); (W.-B.J.); (T.H.V.L.); (V.K.R.); (J.C.)
- Convergence Stem Cell Research Center, Pusan National University, Yangsan 50612, Korea;
| | - Woong-Bi Jang
- Laboratory for Vascular Medicine and Stem Cell Biology, Department of Physiology, Medical Research Institute, School of Medicine, Pusan National University, Yangsan 50612, Korea; (T.T.G.L.); (J.Y.); (J.-S.H.); (Y.-J.K.); (W.-B.J.); (T.H.V.L.); (V.K.R.); (J.C.)
- Convergence Stem Cell Research Center, Pusan National University, Yangsan 50612, Korea;
| | - Thi Hong Van Le
- Laboratory for Vascular Medicine and Stem Cell Biology, Department of Physiology, Medical Research Institute, School of Medicine, Pusan National University, Yangsan 50612, Korea; (T.T.G.L.); (J.Y.); (J.-S.H.); (Y.-J.K.); (W.-B.J.); (T.H.V.L.); (V.K.R.); (J.C.)
- Convergence Stem Cell Research Center, Pusan National University, Yangsan 50612, Korea;
| | - Vinoth Kumar Rethineswaran
- Laboratory for Vascular Medicine and Stem Cell Biology, Department of Physiology, Medical Research Institute, School of Medicine, Pusan National University, Yangsan 50612, Korea; (T.T.G.L.); (J.Y.); (J.-S.H.); (Y.-J.K.); (W.-B.J.); (T.H.V.L.); (V.K.R.); (J.C.)
- Convergence Stem Cell Research Center, Pusan National University, Yangsan 50612, Korea;
| | - Jaewoo Choi
- Laboratory for Vascular Medicine and Stem Cell Biology, Department of Physiology, Medical Research Institute, School of Medicine, Pusan National University, Yangsan 50612, Korea; (T.T.G.L.); (J.Y.); (J.-S.H.); (Y.-J.K.); (W.-B.J.); (T.H.V.L.); (V.K.R.); (J.C.)
- Convergence Stem Cell Research Center, Pusan National University, Yangsan 50612, Korea;
| | - Jae-Ho Kim
- Convergence Stem Cell Research Center, Pusan National University, Yangsan 50612, Korea;
| | - Sang-Hyun Min
- New Drug Development Center, Deagu Gyeongbuk Medical Innovation Foundation, Deagu 41061, Korea;
| | - Dong-Hyung Lee
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan 50612, Korea; (D.-H.L.); (J.-S.Y.)
| | - Ju-Seok Yang
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan 50612, Korea; (D.-H.L.); (J.-S.Y.)
| | - Joo-Seop Chung
- Department of Hematology-Oncology, Pusan National University Hospital Medical Research Institute, Busan 49241, Korea
| | - Sang-Mo Kwon
- Laboratory for Vascular Medicine and Stem Cell Biology, Department of Physiology, Medical Research Institute, School of Medicine, Pusan National University, Yangsan 50612, Korea; (T.T.G.L.); (J.Y.); (J.-S.H.); (Y.-J.K.); (W.-B.J.); (T.H.V.L.); (V.K.R.); (J.C.)
- Convergence Stem Cell Research Center, Pusan National University, Yangsan 50612, Korea;
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Thorny ground, rocky soil: Tissue-specific mechanisms of tumor dormancy and relapse. Semin Cancer Biol 2022; 78:104-123. [PMID: 33979673 PMCID: PMC9595433 DOI: 10.1016/j.semcancer.2021.05.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 02/07/2023]
Abstract
Disseminated tumor cells (DTCs) spread systemically yet distinct patterns of metastasis indicate a range of tissue susceptibility to metastatic colonization. Distinctions between permissive and suppressive tissues are still being elucidated at cellular and molecular levels. Although there is a growing appreciation for the role of the microenvironment in regulating metastatic success, we have a limited understanding of how diverse tissues regulate DTC dormancy, the state of reversible quiescence and subsequent awakening thought to contribute to delayed relapse. Several themes of microenvironmental regulation of dormancy are beginning to emerge, including vascular association, co-option of pre-existing niches, metabolic adaptation, and immune evasion, with tissue-specific nuances. Conversely, DTC awakening is often associated with injury or inflammation-induced activation of the stroma, promoting a proliferative environment with DTCs following suit. We review what is known about tissue-specific regulation of tumor dormancy on a tissue-by-tissue basis, profiling major metastatic organs including the bone, lung, brain, liver, and lymph node. An aerial view of the barriers to metastatic growth may reveal common targets and dependencies to inform the therapeutic prevention of relapse.
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5
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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.
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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
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6
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Rout S, Rai S, Dabkara D, Ghosh J, Chakraborty B, Roy A, Ghosh A, Bhaumik J. Managing Brain Lesions in Gynecological Cancers: A Case Series. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2020. [DOI: 10.1007/s40944-020-00409-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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7
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Bhambhvani HP, Granucci M, Rodrigues A, Kakusa BW, Hayden Gephart M. The primary sites leading to brain metastases: Shifting trends at a tertiary care center. J Clin Neurosci 2020; 80:121-124. [PMID: 33099333 DOI: 10.1016/j.jocn.2020.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/24/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
Abstract
While the majority of brain metastases arise from lung cancer, breast cancer, or melanoma, new treatments and improved prognoses have altered the profile of primary cancers that metastasize to the brain. We sought to determine the proportion of brain metastases from less common primary sites and conduct trend analyses. We reviewed the charts of 3585 patients with brain metastases seen at our institution from 2008 to 2018. We determined the primary site for each of these patients, and the Mann-Kendall test was used to evaluate temporal trends in the yearly proportion of brain metastases originating from each primary cancer. The five most common primary sites were lung (43.0%), breast (19.9%), melanoma (8.2%), renal (5.0%), and colorectal (3.8%). The proportion of yearly brain metastases originating from breast cancer (p = 0.029) and melanoma (p = 0.013) decreased by 23.8% and 46.7%, respectively, from 2008 (0.21 breast, 0.15 melanoma) to 2018 (0.16 breast, 0.08 melanoma), while no change was found in the proportion of brain metastases from lung, renal, and colorectal cancers. Brain metastases arising from rare primary sites, defined as those comprising at most 2% of all brain metastases, increased by 34.4% (p = 0.005). Limited sample size prohibited trend analysis of other individual primary sites. We report a decrease over 11 years in the proportion of brain metastases originating from breast cancer and melanoma at our institution, and an increase in brain metastases from rare primary sites. Further work with larger, multi-center databases will enable additional evaluation of brain metastases from rare primary sites.
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Affiliation(s)
- Hriday P Bhambhvani
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, USA
| | - Monica Granucci
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, USA
| | - Adrian Rodrigues
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, USA
| | - Bina W Kakusa
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, USA
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8
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Romani C, Zizioli V, Silvestri M, Ardighieri L, Bugatti M, Corsini M, Todeschini P, Marchini S, D'Incalci M, Zanotti L, Ravaggi A, Facchetti F, Gambino A, Odicino F, Sartori E, Santin AD, Mitola S, Bignotti E, Calza S. Low Expression of Claudin-7 as Potential Predictor of Distant Metastases in High-Grade Serous Ovarian Carcinoma Patients. Front Oncol 2020; 10:1287. [PMID: 32850397 PMCID: PMC7417514 DOI: 10.3389/fonc.2020.01287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/22/2020] [Indexed: 12/15/2022] Open
Abstract
High-grade serous ovarian carcinoma (HGSOC) usually spreads directly into the peritoneal cavity following a transcoelomic dissemination route, although distant hematogenous metastasis exist and have been reported. However, no tumor markers can currently predict the risk of distant metastases in HGSOC. Claudins, belonging to tight-junction proteins, are dysregulated in HGSOC and functionally related to cancer progression. Here we analyzed claudin-3, -4, and -7 expression as potential markers of distant metastases. Using quantitative RT-PCR and immunohistochemistry we assessed the expression of claudins in primary HGSOC tissues, normal ovarian, and normal fallopian tube epithelia and correlated it with clinicopathological features, including the site of metastasis and the route of dissemination. Gene set enrichment analysis was performed on microarray-generated gene expression data to investigate key pathways in patients with distant metastases. We found the overall expression level of claudin-3, -4, and -7 mRNA decreased in HGSOC compared to normal tubal epithelium, currently considered the potential site of origin of many HGSOC. The reduced expression of claudin-7 is significantly associated with the development of distant metastases (p = 0.016), mainly by hematogenous route (p = 0.025). In patients with diminished expression of claudin-7, immunohistochemical staining revealed a heterogeneous pattern of membranous staining with discontinuous expression of claudin-7 along the cell border, indicative of a dischoesive architecture. The estimated reduction in the probability of distant disease is of 39% per unit increase in the level of claudin-7 (p = 0.03). Genes involved in epithelial to mesenchymal transition, hypoxia, and angiogenesis processes resulted strongly associated to hematogenous recurrence. Our data suggest a potential role of claudin-7 in discriminating distant metastatic events in HGSOC patients. The quantification of its expression levels could be a useful tool to identify patient deserving a personalized follow-up in terms of clinical and radiological assessment.
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Affiliation(s)
- Chiara Romani
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
- Division of Obstetrics and Gynecology, ‘Angelo Nocivelli’ Institute of Molecular Medicine, University of Brescia and ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Valentina Zizioli
- Division of Obstetrics and Gynecology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Marco Silvestri
- Biomarkers Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
- Unit of Biostatistics and Bioinformatics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Laura Ardighieri
- Department of Pathology, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Mattia Bugatti
- Department of Pathology, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Michela Corsini
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Paola Todeschini
- Division of Obstetrics and Gynecology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Sergio Marchini
- Department of Oncology, IRCCS, “Mario Negri” Institute for Pharmacological Research, Milan, Italy
| | - Maurizio D'Incalci
- Department of Oncology, IRCCS, “Mario Negri” Institute for Pharmacological Research, Milan, Italy
| | - Laura Zanotti
- Division of Obstetrics and Gynecology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Antonella Ravaggi
- Division of Obstetrics and Gynecology, ‘Angelo Nocivelli’ Institute of Molecular Medicine, University of Brescia and ASST-Spedali Civili of Brescia, Brescia, Italy
- Division of Obstetrics and Gynecology, ASST Spedali Civili di Brescia, Brescia, Italy
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Sciences University of Brescia, Brescia, Italy
| | - Fabio Facchetti
- Department of Pathology, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Angela Gambino
- Division of Obstetrics and Gynecology, ASST Spedali Civili di Brescia, Brescia, Italy
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Sciences University of Brescia, Brescia, Italy
| | - Franco Odicino
- Division of Obstetrics and Gynecology, ASST Spedali Civili di Brescia, Brescia, Italy
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Sciences University of Brescia, Brescia, Italy
| | - Enrico Sartori
- Division of Obstetrics and Gynecology, ASST Spedali Civili di Brescia, Brescia, Italy
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Sciences University of Brescia, Brescia, Italy
| | - Alessandro Davide Santin
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
| | - Stefania Mitola
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Eliana Bignotti
- Division of Obstetrics and Gynecology, ‘Angelo Nocivelli’ Institute of Molecular Medicine, University of Brescia and ASST-Spedali Civili of Brescia, Brescia, Italy
- Division of Obstetrics and Gynecology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Stefano Calza
- Unit of Biostatistics and Bioinformatics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
- Big & Open Data Innovation Laboratory, University of Brescia, Brescia, Italy
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Brain Metastases from Ovarian Cancer: Current Evidence in Diagnosis, Treatment, and Prognosis. Cancers (Basel) 2020; 12:cancers12082156. [PMID: 32759682 PMCID: PMC7464214 DOI: 10.3390/cancers12082156] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 12/12/2022] Open
Abstract
With this review, we provide the state of the art concerning brain metastases (BMs) from ovarian cancer (OC), a rare condition. Clinical, pathological, and molecular features, treatment options, and future perspectives are comprehensively discussed. Overall, a diagnosis of high-grade serous OC and an advanced disease stage are common features among patients who develop brain metastases. BRCA1 and BRCA2 gene mutations, as well as the expression of androgen receptors in the primary tumor, are emerging risk and prognostic factors which could allow one to identify categories of patients at greater risk of BMs, who could benefit from a tailored follow-up. Based on present data, a multidisciplinary approach combining surgery, radiotherapy, and chemotherapy seem to be the best approach for patients with good performance status, although the median overall survival (<1 year) remains largely disappointing. Hopefully, novel therapeutic avenues are being explored, like PARP inhibitors and immunotherapy, based on our improved knowledge regarding tumor biology, but further investigation is warranted.
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10
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Xi S, Li Z, Guo Q, Lin W, Liang X, Ma L. Prognostic Factors among Brain Metastases in Newly Diagnosed Ovary Cancer: A Large Real-world Study. J Cancer 2020; 11:4625-4640. [PMID: 32489480 PMCID: PMC7255353 DOI: 10.7150/jca.44494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/27/2020] [Indexed: 01/06/2023] Open
Abstract
Background: Population-based data on the prognosis of brain metastases at initial diagnosis of ovary cancer (OCBM) are currently lacking. Besides, the effective treatment for OCBM patients is still controversial now. The study aimed to explore the prognostic factors among OCBM. Methods: We retrospectively reviewed the OCBM patients from the Surveillance, Epidemiology, and End Result (SEER) database of the National Cancer Institute to investigate predictors of the presence of OCBM and its' prognostic factors related to all-cause mortality. We employed multivariable logistic and Cox regression analysis. Furthermore, to minimize the impact of potential confounding factors, we conducted a 1:1 propensity score matching (PSM) analysis. Results: A total of 29,512 cases of OC patients entered into the study, including 89 patients with brain metastases of ovarian cancer, which accounted for 0.30% of the entire cohort and 12.02% of the metastatic disease subset. We identified eight factors, including laterality, histology, surgery, radiotherapy, chemotherapy, and extracranial metastatic sites to bone, liver, and lung, as predictors of OCBM based on multivariable logistic regression among the entire cohort. The median survival time of OCBM was 2.0 months, and the interquartile range was 2.0-10.0 mo. The patients who received comprehensive treatment had better prognosis. Based on the multivariable Cox model, marital status, surgery, chemotherapy, and extensive therapy (including RSC, SC, and RC) were identified as predictors of OS. Besides, a new factor (brain metastasis) was identified by 1:1 PSM -based multiple Cox regression, apart from the above prognostic factors for OS. Conclusions: This study provided a population-based estimate of the proportion and prognosis for newly diagnosed ovary cancer with brain metastases. These findings may add materials to guidelines for preliminary screening and optimal treatment of OCBM patients.
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Affiliation(s)
- Sujuan Xi
- The Reproductive Medical Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518107, China
| | - Zaiyi Li
- The Reproductive Medical Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518107, China
| | - Quan Guo
- Department of gynaechology, Shengjing Hospital Medical University, Shenyang, China
| | - Wenjing Lin
- The Reproductive Medical Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518107, China
| | - Xiaokun Liang
- Shenzhen Colleges of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, Guangdong, 518055 China
| | - Lin Ma
- The Reproductive Medical Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518107, China
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11
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Mittica G, Goia M, Gambino A, Scotto G, Fonte M, Senetta R, Aglietta M, Borella F, Sapino A, Katsaros D, Maggiorotto F, Ghisoni E, Giannone G, Tuninetti V, Genta S, Eusebi C, Momi M, Cassoni P, Valabrega G. Validation of Androgen Receptor loss as a risk factor for the development of brain metastases from ovarian cancers. J Ovarian Res 2020; 13:53. [PMID: 32366278 PMCID: PMC7199337 DOI: 10.1186/s13048-020-00655-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/24/2020] [Indexed: 12/21/2022] Open
Abstract
Background Central nervous system (CNS) spreading from epithelial ovarian carcinoma (EOC) is an uncommon but increasing phenomenon. We previously reported in a small series of 11 patients a correlation between Androgen Receptor (AR) loss and localization to CNS. Aims of this study were: to confirm a predictive role of AR loss in an independent validation cohort; to evaluate if AR status impacts on EOC survival. Results We collected an additional 29 cases and 19 controls as validation cohort. In this independent cohort at univariate analysis, cases exhibited lower expression of AR, considered both as continuous (p < 0.001) and as discrete variable (10% cut-off: p < 0.003; Immunoreactive score: p < 0.001). AR negative EOC showed an odds ratio (OR) = 8.33 for CNS dissemination compared with AR positive EOC. Kaplan-Meier curves of the combined dataset, combining data of new validation cohort with the previously published cohort, showed that AR < 10% significantly correlates with worse outcomes (p = 0.005 for Progression Free Survival (PFS) and p = 0.002 for brain PFS (bPFS) respectively). Comparison of AR expression between primary tissue and paired brain metastases in the combined dataset did not show any statistically significant difference. Conclusions We confirmed AR loss as predictive role for CNS involvement from EOC in an independent cohort of cases and controls. Early assessment of AR status could improve clinical management and patients’ prognosis.
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Affiliation(s)
- Gloria Mittica
- Unit of Oncology, ASL Verbano Cusio Ossola (VCO), Domodossola, Italy
| | - Margherita Goia
- Unit of Pathology, Città della Salute e della Scienza, Turin, Italy.,Department of Medical Sciences, University of Turin, Turin, Italy
| | - Angela Gambino
- Department Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Giulia Scotto
- Department of Oncology, University of Torino, Turin, Italy. .,Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy.
| | - Mattia Fonte
- Department of Oncology, University of Torino, Turin, Italy
| | - Rebecca Senetta
- Unit of Pathology, Città della Salute e della Scienza, Turin, Italy.,Department of Medical Sciences, University of Turin, Turin, Italy
| | - Massimo Aglietta
- Department of Oncology, University of Torino, Turin, Italy.,Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy
| | - Fulvio Borella
- Department of Surgical Sciences, Gynecology, AOU, Città della Salute e della Scienza, Turin, Italy
| | - Anna Sapino
- Department of Medical Sciences, University of Turin, Turin, Italy.,Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy
| | - Dionyssios Katsaros
- Department of Surgical Sciences, Gynecology, AOU, Città della Salute e della Scienza, Turin, Italy
| | | | - Eleonora Ghisoni
- Department of Oncology, University of Torino, Turin, Italy.,Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy
| | - Gaia Giannone
- Department of Oncology, University of Torino, Turin, Italy.,Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy
| | - Valentina Tuninetti
- Department of Oncology, University of Torino, Turin, Italy.,Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy
| | - Sofia Genta
- Department of Oncology, University of Torino, Turin, Italy.,Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy
| | - Chiara Eusebi
- Department Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Marina Momi
- Department Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Paola Cassoni
- Unit of Pathology, Città della Salute e della Scienza, Turin, Italy.,Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giorgio Valabrega
- Department of Oncology, University of Torino, Turin, Italy.,Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy
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12
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Halassy S, Au K, Chobanian N. Metastatic brain disease in early stage ovarian cancer: A case report. Gynecol Oncol Rep 2020; 32:100540. [PMID: 32090166 PMCID: PMC7026300 DOI: 10.1016/j.gore.2020.100540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/14/2020] [Accepted: 01/27/2020] [Indexed: 11/28/2022] Open
Abstract
Patient with history of early stage ovarian cancer with singular brain lesion. Head imaging with finding of mass effect and edema requiring surgical intervention. Ovarian cancer metastasizes locally and rarely to the brain. Brain metastases commonly are multiple, and rarely singular. The most significant risk factor for brain metastasis includes advanced stage disease.
Ovarian cancer rarely metastasizes to the brain. If it does, it is more likely to occur with advanced stage carcinomas, more than one year after diagnosis, and rarely presents as a single lesion. Early detection, treatment, and close follow-up is essential to optimize prognosis and prevent long-term disability. This case presents a 54-year-old female with a previously diagnosed & treated stage 1a, grade 3 ovarian cancer who presented with a complaint of persistent headache. Imaging demonstrated a singular brain lesion. She underwent mass resection with pathology consistent with metastatic ovarian cancer. This was only 18 months after her primary diagnosis, demonstrating the importance of close surveillance and heightened awareness of metastatic disease.
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Affiliation(s)
- Sophia Halassy
- Ascension Providence Hospital, Department of Obstetrics & Gynecology, Southfield, MI, United States.,Michigan State University, East Lansing, MI, United States
| | - Katrina Au
- School of Medicine, St. George's University, True Blue, Grenada
| | - Nishan Chobanian
- Ascension Providence Hospital, Department of Obstetrics & Gynecology, Southfield, MI, United States.,Michigan State University, East Lansing, MI, United States
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13
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Kemppainen J, Hynninen J, Virtanen J, Seppänen M. PET/CT for Evaluation of Ovarian Cancer. Semin Nucl Med 2019; 49:484-492. [DOI: 10.1053/j.semnuclmed.2019.06.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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14
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Treatment Results and Prognostic Factors of Brain Metastases From Ovarian Cancer: A Single Institutional Experience of 56 Patients. Int J Gynecol Cancer 2019; 28:1631-1638. [PMID: 30247251 DOI: 10.1097/igc.0000000000001341] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES The most appropriate treatments for brain metastases from ovarian cancer have not been established mainly because of its rarity. The objective of this study was to describe clinical results of treatment and prognostic factors of patients with brain metastases from ovarian cancer treated at a single institution. MATERIALS AND METHODS We retrieved information from the electronic medical records of 56 consecutive patients (2.8%) with brain metastases, from a total of 2008 patients with ovarian cancer. Endpoints were the pattern of treatment failure, progression-free survival, and overall survival (OS). RESULTS Radiation was the most common initial treatment for brain metastases (59%), followed by surgery (23%). The median progression-free survival was 9.8 months. Radiological progression was confirmed in 20 patients: 7 had leptomeningeal carcinomatosis (37%), 8 had local recurrence, and 5 had distant recurrence. Median OS was 11.25 months, and the 1-year OS rate was 48.2%. Patients received surgery for single metastasis as initial treatment showed median OS of 24.1 months, which was significantly prolonged compared with the other patients (P = 0.0002). Of the 48 patients who died, 29 (60%) died of systemic disease and 7 (15%) died of central nervous system progression. Karnofsky Performance Status greater than or equal to 70, control of systemic cancer, serous histology, and surgery for brain metastases were associated with improved OS in multivariable analysis (P < 0.05). CONCLUSIONS Surgical resection for single or symptomatic brain metastases from ovarian cancer prolonged OS significantly. Multimodality treatment, including control of systemic cancer, appeared to be an important factor in prolonging OS.
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15
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Ratner E, Bala M, Louie-Gao M, Aydin E, Hazard S, Brastianos PK. Increased risk of brain metastases in ovarian cancer patients with BRCA mutations. Gynecol Oncol 2019; 153:568-573. [PMID: 30876674 DOI: 10.1016/j.ygyno.2019.03.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/01/2019] [Accepted: 03/04/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE To estimate the risk for brain metastases in patients with ovarian cancer using real-world data, and assess whether BRCA mutations increase that risk. METHODS This retrospective study included 4515 patients diagnosed with ovarian cancer between January 1, 2011, and January 31, 2018, from the Flatiron Health database, a longitudinal, demographically, and geographically diverse database derived from electronic health records in the United States. RESULTS Forty-six (1%) patients were diagnosed with brain metastases after being diagnosed with ovarian cancer. Of 4515 patients with ovarian cancer, 10% had a known BRCA mutation, 37% had BRCA wildtype (BRCAwt), and the BRCA status of the remaining 51% was unknown/untested. Brain metastases were observed in 3% of patients with BRCA mutations compared with 0.6% of those with BRCAwt. The Kaplan-Meier estimate for the proportion of patients with brain metastases within 5 years of diagnosis was 5.7% in the population with BRCA mutations compared with 1.4% in those with BRCAwt (hazard ratio 4.44; 95% confidence interval, 1.97, 10.00; P < 0.0001). These data demonstrate that patients with a BRCA mutation had a significantly higher risk for brain metastases than those without. CONCLUSION Despite being a rare manifestation of ovarian cancer, the possibility of developing brain metastases should be considered in these patients, especially in patients with a BRCA mutation. The availability of new therapeutic options that may prolong overall survival and may not cross the blood-brain barrier could also lead to an increase in brain metastases in patients with ovarian cancer.
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Affiliation(s)
- Elena Ratner
- Obstetrics, Gynecology, and Reproductive Sciences, Yale University, 800 Howard Avenue, New Haven, CT 06519, USA
| | - Mohan Bala
- TESARO, Inc., 1000 Winter Street, Waltham, MA 02451, USA
| | | | - Ebru Aydin
- TESARO, Inc., 1000 Winter Street, Waltham, MA 02451, USA
| | | | - Priscilla K Brastianos
- Harvard Medical School, Hematology/Oncology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 9E, Boston, MA 02114, USA.
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16
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Sadik ZHA, Beerepoot LV, Hanssens PEJ. Efficacy of gamma knife radiosurgery in brain metastases of primary gynecological tumors. J Neurooncol 2019; 142:283-290. [PMID: 30666465 DOI: 10.1007/s11060-019-03094-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 01/08/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Gynecological brain metastases (BM) are rare and usually develop as part of widespread disseminated disease. Despite treatment, the majority of these patients do not survive > 1 year due to advanced extracranial disease. The use of Gamma Knife Radiosurgery (GKRS) for gynecological BM is not well known. The goal of this study is to evaluate the efficacy of GKRS for gynecological BM. METHODS We performed a retrospective study of patients with gynecological BM who underwent GKRS between 2002 and 2015. A total of 41 patients were included. Outcome measures were local tumor control (LC), development of new BM and/or leptomeningeal disease, overall intracranial progression free survival (PFS) and survival. RESULTS LC was 100%, 92%, 80%, 75% and 67% at 3, 6, 9, 12 and 15 months, respectively. PFS was 90%, 61%, 41%, 23% and 13% at 3, 6, 9, 12 and 15 months, respectively. During follow-up (FU), 18 (44%) patients had intracranial progression. Distant BM occurred in 29% of the patients. Local recurrence and distant recurrence occurred after a mean FU time of 15.5 (2.6-71.9) and 11.4 (2-40) months, respectively. Thirty-one (76%) patients died due to extracranial tumor progression and only 2 (5%) patients died due to progressive intracranial disease. The overall mean survival from time of GKRS was 19 months (1-109). The 6-month, 1-year, and 2-year survival rate from the time of GKRS were 71%, 46%, and 22%, respectively. CONCLUSION GKRS is a good treatment option for controlling gynecological BM. As most patients die due to extracranial tumor progression, their survival might improve with better systemic treatment options in addition to GKRS.
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Affiliation(s)
- Zjiwar H A Sadik
- Gamma Knife Center, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands. .,Department of Neurosurgery, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands. .,Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Laurens V Beerepoot
- Department of Medical Oncology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
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17
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Keskin S, Küçücük S, Ak N, Atalar B, Sarı M, Sozen H, Ibis K, Topuz S, Saip P. Survival Impact of Optimal Surgical Cytoreduction in Recurrent Epithelial Ovarian Cancer with Brain Metastasis. Oncol Res Treat 2019; 42:101-106. [PMID: 30661076 DOI: 10.1159/000494334] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 10/05/2018] [Indexed: 11/19/2022]
Abstract
AIM The aim of this study was to determine the clinicopathological characteristics, treatment details and outcome of patients with brain metastasis from epithelial ovarian carcinoma (EOC). METHODS This study included 21 patients diagnosed with brain metastasis from EOC between 1999 and 2009. RESULTS Median age was 61 years (range 38-77). The median time elapsed from EOC diagnosis to brain metastasis detection was 32 months. Single brain metastases were found in 10 (48%) cases, and there was extra-cranial disease in 11 (52%) cases. During the mean 86 months of follow-up, 18 of the patients (86%) died of the disease and 3 (14%) were alive with disease. The median survival time after the initial diagnosis of brain metastasis was 9 months. The median overall survival (OS) from initial diagnosis of EOC was 50 months. In univariate analysis, prolonged time from initial diagnosis to central nervous system metastasis (more than 32 months) (p = 0.001), treatment with radiotherapy (p < 0.001), optimal cytoreductive operation (p = 0.02) were all positively correlated with OS. CONCLUSION The prognosis of patients with brain metastasis from EOC is still poor. The significant predictors of survival in our series were whole brain radiotherapy, prolonged elapsed time from initial diagnosis to brain metastasis and optimal cytoreductive surgery.
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18
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Abstract
Brain metastases (BM) are the most commonly diagnosed type of central nervous system tumor in the United States. Estimates of the frequency of BM vary significantly, as there is no nationwide reporting system for metastases. BM may be the first sign of a previously undiagnosed cancer, or occur years or decades after the primary cancer was diagnosed. Incidence of BM varies significantly by primary cancer site. Lung, breast, and melanoma continue to be the leading cause of BM. These tumors are increasingly more common as new therapeutics, advanced imaging, and improved screening have led to lengthened survival after primary diagnosis for cancer patients. BM are difficult to treat, and for most individuals the diagnosis of BM generally portends a poor prognosis.
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Affiliation(s)
- Quinn T Ostrom
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Christina Huang Wright
- Brain Tumor and Neuro-oncology Center, Department of Neurosurgery, University Hospitals Case Medical Center, Case Western Reserve School of Medicine, Cleveland, OH, United States
| | - Jill S Barnholtz-Sloan
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, United States.
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19
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Mittica G, Senetta R, Scotto G, Aglietta M, Maggiorotto F, Ghisoni E, Genta S, Boldorini R, Manini C, Morra I, Buosi R, Sapino A, Cassoni P, Valabrega G. Androgen receptor status predicts development of brain metastases in ovarian cancers. Oncotarget 2018; 8:41143-41153. [PMID: 28467804 PMCID: PMC5522232 DOI: 10.18632/oncotarget.17068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 03/17/2017] [Indexed: 12/20/2022] Open
Abstract
Brain metastases are uncommon localizations in epithelial ovarian cancer (EOC), their reported incidence is increasing and no predictive biomarkers have been identified yet. Goals of this study were: i) to define a possible association between Estrogen Receptor (ER), Progesterone Receptor (PR), Androgen Receptor (AR), human EGF receptor 2 (HER2) and brain progression in EOC patients, and ii) to identify differences in ER, PR, AR and HER2 protein expression from primary EOC and its matched resected brain metastasis. A retrospective series of 11 EOC with matched brain metastasis surgically removed was collected. For comparison, a “Control dataset” of 22 patients, without evidence of brain involvement after an adequate follow up was matched. ER, PR, AR and HER2 status were analyzed by means of immunohistochemistry forCases (both primary and metastatic lesions) and Controls. Univariate analysis showed that AR status was significantly associated with brain localization, both considered as discrete variable (cut-off: 10%, p=0.013) and as continuous one (p=0.035). Multivariate analysis confirmed this trend (p=0.053). When considered as continuous variables, ER and AR showed greater expression in primary tumors in comparison with brain metastases (p=0.013 and p=0.032, respectively). In our series, AR predicts brain involvement, with a 9.5 times higher propensity for AR-negative EOC. Moreover, brain dissemination is probably the result of progressive dedifferentiation of primary tumor, shown by reduction of ER and AR expression in metastases. Further studies are required, in order to anticipate and improve multimodal treatment of brain metastases.
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Affiliation(s)
- Gloria Mittica
- Department of Oncology, University of Turin, Turin, Italy.,Division of Medical Oncology-1, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Italy
| | - Rebecca Senetta
- Unit of Pathology Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Italy
| | - Giulia Scotto
- Department of Oncology, University of Turin, Turin, Italy
| | - Massimo Aglietta
- Department of Oncology, University of Turin, Turin, Italy.,Division of Medical Oncology-1, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Italy
| | - Furio Maggiorotto
- Division of Gynecologic Oncology, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Italy
| | - Eleonora Ghisoni
- Department of Oncology, University of Turin, Turin, Italy.,Division of Medical Oncology-1, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Italy
| | - Sofia Genta
- Department of Oncology, University of Turin, Turin, Italy.,Division of Medical Oncology-1, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Italy
| | - Renzo Boldorini
- Department of Health Science, University of Eastern Piedmont "Amedeo Avogadro", Novara, Italy
| | - Claudia Manini
- Unit of Pathology, Giovanni Bosco Hospital, Turin, Italy
| | - Isabella Morra
- Unit of Pathology, Città della Salute e della Scienza, Turin, Italy
| | - Roberta Buosi
- Division of Oncology, Santo Spirito Hospital, Casale Monferrato, Italy
| | - Anna Sapino
- Unit of Pathology Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Italy.,Department of Medical Sciences, University of Turin, Turin, Italy
| | - Paola Cassoni
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giorgio Valabrega
- Department of Oncology, University of Turin, Turin, Italy.,Division of Medical Oncology-1, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Italy
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20
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Ben Kridis W, Sghaier S, Toumi N, Khanfir A, Daoud J, Frikha M. An exceptional evolution of primary peritoneal serous carcinoma. Acta Clin Belg 2017; 72:439-442. [PMID: 28271744 DOI: 10.1080/17843286.2017.1300216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Primary peritoneal serous carcinoma (PPSC) is a rare malignancy of the peritoneum. Clinically and histopathologically, PPSC is similar to serous ovarian papillary carcinoma. Brain metastases (BM) from PPSC are exceedingly rare. We report here a new case of BM two years after complete remission from a PPSC, to make aware physicians about this entity. This case is exceptional; firstly given the rarity of this entity and secondly due to the good response after radiotherapy then systemic chemotherapy with Carboplatin and Paclitaxel.
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Affiliation(s)
- Wala Ben Kridis
- Department of Oncology, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Syrine Sghaier
- Department of Oncology, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Nabil Toumi
- Department of Oncology, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Afef Khanfir
- Department of Oncology, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Jamel Daoud
- Department of Radiotherapy, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Mounir Frikha
- Department of Oncology, Habib Bourguiba Hospital, Sfax, Tunisia
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21
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Shin HK, Kim JH, Lee DH, Cho YH, Kwon DH, Roh SW. Clinical Outcomes of Gamma Knife Radiosurgery for Metastatic Brain Tumors from Gynecologic Cancer : Prognostic Factors in Local Treatment Failure and Survival. J Korean Neurosurg Soc 2016; 59:392-9. [PMID: 27446522 PMCID: PMC4954889 DOI: 10.3340/jkns.2016.59.4.392] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/21/2016] [Accepted: 04/07/2016] [Indexed: 01/20/2023] Open
Abstract
Objective Brain metastases in gynecologic cancer (ovarian, endometrial, and cervical cancer) patients are rare, and the efficacy of Gamma Knife Radiosurgery (GKRS) to treat these had not been evaluated. We assessed the efficacy of GKRS and prognostic factors for tumor control and survival in brain metastasis from gynecologic cancers. Methods This retrospective study was approved by the institutional review board. From May 1995 to October 2012, 26 women (mean age 51.3 years, range 27–70 years) with metastatic brain tumors from gynecologic cancer were treated with GKRS. We reviewed their outcomes, radiological responses, and clinical status. Results In total 24 patients (59 lesions) were available for follow-up imaging. The median follow-up time was 9 months. The mean treated tumor volume at the time of GKRS was 8185 mm3 (range 10–19500 mm3), and the median dose delivered to the tumor margin was 25 Gy (range, 10–30 Gy). A local tumor control rate was 89.8% (53 of 59 tumors). The median overall survival was 9.5 months after GKRS (range, 1–102 months). Age-associated multivariate analysis indicated that the Karnofsky performance status (KPS), the recursive partitioning analysis (RPA) classification, and the number of treated lesions were significant prognostic factors for overall survival (HR=0.162, p=0.008, HR=0.107, p=0.038, and HR=2.897, p=0.045, respectively). Conclusion GKRS is safe and effective for the management of brain metastasis from gynecologic cancers. The clinical status of the patient is important in determining the overall survival time.
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Affiliation(s)
- Hong Kyung Shin
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hoon Kim
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Heui Lee
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Hyun Cho
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Hoon Kwon
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Woo Roh
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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22
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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.
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23
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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.
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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
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Shepard MJ, Fezeu F, Lee CC, Sheehan JP. Gamma knife radiosurgery for the treatment of gynecologic malignancies metastasizing to the brain: clinical article. J Neurooncol 2014; 120:515-22. [PMID: 25129546 DOI: 10.1007/s11060-014-1577-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 08/03/2014] [Indexed: 12/30/2022]
Abstract
Gynecologic malignancies represent some of the commonest causes of cancer in the female population. Despite their overall high prevalence, gynecologic malignancies have seldom been reported to metastasize to the brain. The incidence of gynecologic cancers spreading to the brain has been rising, and the optimal management of these patients is not well defined. A retrospective analysis of patients treated over the past ten years with gamma knife radiosurgery (GKRS) for metastatic gynecologic cancer to the brain was performed. Radiographic treatment response, tumor control, metastatic disease progression and survival data were analyzed. Eight patients with ovarian cancer, six patients with endometrial cancer and two separates who carried a diagnosis of cervical cancer or leiomyosarcoma harbored metastatic disease to the brain that was treated with GKRS. The median dose to the tumor margin was 20 Gy (range 10-22 Gy), and the median maximum radiosurgical dose was 31 Gy (range 16-52.9 Gy). Tumor control was achieved in all patients who had follow up imaging studies. Patients with ovarian cancer had prolonged median survival following GKRS compared to patients with endometrial cancer (22.3 vs 8.3 months, p = 0.02). The patient with cervical cancer survived 8 months following her GKRS in the setting of metastatic brain tumor progression, whereas the patient with leiomyosarcoma passed away within several weeks of treatment secondary to disseminated extracranial primary disease. GKRS is a safe and effective means of achieving intracranial tumor control for patients with gynecologic cancer that has spread to the brain.
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Affiliation(s)
- Matthew J Shepard
- Department of Neurological Surgery, University of Virginia Health System, P.O. Box 800212, Charlottesville, VA, 22908, USA,
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Longo R, Platini C, Eid N, Elias-Matta C, Buda T, 'Nguyen D, Quétin P. A late, solitary brain metastasis of epithelial ovarian carcinoma. BMC Cancer 2014; 14:543. [PMID: 25069863 PMCID: PMC4122771 DOI: 10.1186/1471-2407-14-543] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 07/17/2014] [Indexed: 12/14/2022] Open
Abstract
Background Brain metastasis from epithelial ovarian cancer (EOC) is very rare with a reported incidence of less than 2%. It is usually associated with a poor prognosis that is related to several factors, the most important including: single vs multiple lesions, performance status, platinum-sensitive disease, tumor grade, extracranial disease, and multimodal approach treatment. At the time of diagnosis, an extracranial disease is found in over half of patients. The most common histology is the serous type. The median time from primary diagnosis to development of cerebral lesions is directly correlated to initial tumor grade and stage. Several therapeutic approaches can be proposed, including best supportive care +/- corticosteroids, surgery, radiotherapy and chemotherapy. A multimodal therapy approach may achieve an improved outcome and should therefore be utilized whenever applicable. Case presentation We present the case of a patient with a solitary brain metastasis which appeared 11 years after a locally advanced and aggressive EOC (FIGO stage III C) and which totally regressed after surgery and adjuvant chemotherapy. Clinically, she showed progressive headaches, decreased visual acuity, balance and memory disorders associated with a confusional state. Brain CT scan and MRI documented a solitary, necrotic lesion in the left central parietal region with an important cerebral surrounding edema and initial cranial herniation. No other extracranial metastases were observed at the PET scan. Laboratory tests were in the normal range and CA 125 was moderatly increased at 81 UI/ml. The patient underwent surgical removal of tumor lesion, post-surgical whole-brain radiotherapy (WBRT) and systemic chemotherapy with carboplatin alone for six cycles. At a follow-up of 13 months, she is alive, in good clinical condition and tumor progression free. Conclusion The peculiarity of this case relies on the isolated brain relapse of a BRCA-1/BRCA-2 non-mutated EOC, which is uncommon and rare, and to the very long time, of 11 years, from diagnosis of primary cancer and development of brain metastasis. A multimodal, aggressive approach of this isolated brain metastasis led to a complete and prolonged tumor control.
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Affiliation(s)
- Raffaele Longo
- Division of Medical Oncology, CHR Metz-Thionville, 1 Allée du Château, 57085 Ars-Laquenexy, France.
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Barresi V, Branca G, Caffo M, Caltabiano R, Ieni A, Vitarelli E, Lanzafame S, Tuccari G. Immuno-expression of endoglin and smooth muscle actin in the vessels of brain metastases. Is there a rational for anti-angiogenic therapy? Int J Mol Sci 2014; 15:5663-79. [PMID: 24699047 PMCID: PMC4013588 DOI: 10.3390/ijms15045663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 03/10/2014] [Accepted: 03/25/2014] [Indexed: 12/19/2022] Open
Abstract
Despite ongoing clinical trials, the efficacy of anti-angiogenic drugs for the treatment of brain metastases (BM) is still questionable. The lower response rate to anti-angiogenic therapy in the presence of BM than in metastatic disease involving other sites suggests that BM may be insensitive to these drugs, although the biological reasons underlining this phenomenon are still to be clarified. With the aim of assessing whether the targets of anti-angiogenic therapies are actually present in BM, in the present study, we analyzed the microvessel density (MVD), a measure of neo-angiogenesis, and the vascular phenotype (mature vs. immature) in the tumor tissue of a series of BM derived from different primary tumors. By using immunohistochemistry against endoglin, a specific marker for newly formed vessels, we found that neo-angiogenesis widely varies in BM depending on the site of the primary tumor, as well as on its histotype. According to our results, BM from lung cancer displayed the highest MVD counts, while those from renal carcinoma had the lowest. Then, among BM from lung cancer, those from large cell and adenocarcinoma histotypes had significantly higher MVD counts than those originating from squamous cell carcinoma (p = 0.0043; p = 0.0063). Of note, MVD counts were inversely correlated with the maturation index of the endoglin-stained vessels, reflected by the coverage of smooth muscle actin (SMA) positive pericytes (r = −0.693; p < 0.0001). Accordingly, all the endoglin-positive vessels in BM from pulmonary squamous cell carcinoma and renal carcinoma, displayed a mature phenotype, while vessels with an immature phenotype were found in highly vascularized BM from pulmonary large cell and adenocarcinoma. The low MVD and mature phenotype observed in BM from some primary tumors may account for their low sensitivity to anti-angiogenic therapies. Although our findings need to be validated in correlative studies with a clinical response, this should be taken into account in therapeutic protocols in order to avoid the adverse effects of useless therapies.
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Affiliation(s)
- Valeria Barresi
- Department of Human Pathology "G. Barresi", University of Messina, Messina 98125, Italy.
| | - Giovanni Branca
- Department of Human Pathology "G. Barresi", University of Messina, Messina 98125, Italy.
| | - Maria Caffo
- Department of Neurosciences, University of Messina, Messina 98125, Italy.
| | - Rosario Caltabiano
- Department G.F. Ingrassia, Section of Anatomic Pathology, University of Catania, Catania 95123, Italy.
| | - Antonio Ieni
- Department of Human Pathology "G. Barresi", University of Messina, Messina 98125, Italy.
| | - Enrica Vitarelli
- Department of Human Pathology "G. Barresi", University of Messina, Messina 98125, Italy.
| | - Salvatore Lanzafame
- Department G.F. Ingrassia, Section of Anatomic Pathology, University of Catania, Catania 95123, Italy.
| | - Giovanni Tuccari
- Department of Human Pathology "G. Barresi", University of Messina, Messina 98125, Italy.
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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.
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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
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Proteomic analysis of differential protein expression by brain metastases of gynecological malignancies. Hum Cell 2013; 26:56-66. [PMID: 23504277 PMCID: PMC3676637 DOI: 10.1007/s13577-012-0053-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 10/29/2012] [Indexed: 11/08/2022]
Abstract
Brain metastases of gynecological malignancies are rare, but the incidence is increasing. Patients with brain metastases have a poor prognosis, therefore early detection and optimal management is necessary. In order to determine a new biomarker, we aimed to identify proteins that associated with brain metastases. We investigated proteins associated with brain metastases of gynecological malignancies in three patients who underwent surgical resection (stage IIb cervical cancer, stage Ib endometrial cancer, and stage IIIb ovarian cancer). Proteomic analysis was performed on formalin-fixed paraffin-embedded (FFPE) samples of the primary tumors and brain metastases, which were analyzed by liquid chromatography with tandem mass spectrometry. Thereafter, candidate proteins were identified by the Scaffold system and Mascot search program, and were analyzed using western blotting and immunohistochemistry. As a result, a total of 129 proteins were identified. In endometrial and ovarian cancers, western blotting revealed that the expression of alpha-enolase (ENO1) and triosephosphate isomerase (TPI-1) was higher and the expression of Transgelin-2 (TAGLN2) was lower in metastatic tumors than in primary tumors. On the other hand, the expression of TPI-1 and TAGLN2 was lower in metastatic tumors than in primary tumors in cervical cancer. Immunohistochemistry confirmed that ENO1 expression was elevated in the metastatic tumors compared with the primary tumors. In conclusion, the present study showed that FFPE tissue-based proteomics analysis can be powerful tool, and these findings suggested that ENO1, TPI-1, and TAGLN2 may have a role in the development and progression of brain metastasis from gynecological malignancies.
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Ogino A, Hirai T, Fukushima T, Serizawa T, Watanabe T, Yoshino A, Katayama Y. Gamma knife surgery for brain metastases from ovarian cancer. Acta Neurochir (Wien) 2012; 154:1669-77. [PMID: 22588338 PMCID: PMC3426666 DOI: 10.1007/s00701-012-1376-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Accepted: 04/26/2012] [Indexed: 11/28/2022]
Abstract
Background Brain metastases from ovarian cancer are rare, but their incidence is increasing. The purpose of this study was to investigate the characteristics of brain metastases from ovarian cancer, and to assess the efficacy of treatment with gamma knife surgery (GKS). Methods A retrospective review was performed of patients with brain metastases from ovarian cancer who were treated at the Tokyo Gamma Unit Center from 2006 to 2010. Results Sixteen patients were identified. Their median age at diagnosis of brain metastases was 56.5 years, the median interval from diagnosis of ovarian cancer to brain metastases was 27.5 months, and the median number of brain metastases was 2. The median Karnofsky Performance Score (KPS) at the first GKS was 80. The median survival following diagnosis of brain metastases was 12.5 months, and 6-month and 1-year survival rates were 75 % and 50 %, respectively. The tumor control rate was 86.4 %. The KPS (<80 vs ≥80) and total volume of brain metastases (<10 cm3 vs ≥10 cm3) were significantly associated with survival according to a univariate analysis (p = 0.004 and p = 0.02, respectively). Conclusions The results of this study suggest that GKS is an effective remedy and acceptable choice for the control of brain metastases from ovarian cancer.
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Affiliation(s)
- Akiyoshi Ogino
- Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan.
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Davis FG, Dolecek TA, McCarthy BJ, Villano JL. Toward determining the lifetime occurrence of metastatic brain tumors estimated from 2007 United States cancer incidence data. Neuro Oncol 2012; 14:1171-7. [PMID: 22898372 PMCID: PMC3424213 DOI: 10.1093/neuonc/nos152] [Citation(s) in RCA: 166] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 06/22/2012] [Indexed: 12/15/2022] Open
Abstract
Few population estimates of brain metastasis in the United States are available, prompting this study. Our objective was to estimate the expected number of metastatic brain tumors that would subsequently develop among incident cancer cases for 1 diagnosis year in the United States. Incidence proportions for primary cancer sites known to develop brain metastasis were applied to United States cancer incidence data for 2007 that were retrieved from accessible data sets through Centers for Disease Control and Prevention (CDC Wonder) and Surveillance, Epidemiology, and End Results (SEER) Program Web sites. Incidence proportions were identified for cancer sites, reflecting 80% of all cancers. It was conservatively estimated that almost 70 000 new brain metastases would occur over the remaining lifetime of individuals who received a diagnosis in 2007 of primary invasive cancer in the United States. That is, 6% of newly diagnosed cases of cancer during 2007 would be expected to develop brain metastasis as a progression of their original cancer diagnosis; the most frequent sites for metastases being lung and bronchus and breast cancers. The estimated numbers of brain metastasis will be expected to be higher among white individuals, female individuals, and older age groups. Changing patterns in the occurrence of primary cancers, trends in populations at risk, effectiveness of treatments on survival, and access to those treatments will influence the extent of brain tumor metastasis at the population level. These findings provide insight on the patterns of brain tumor metastasis and the future burden of this condition in the United States.
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Affiliation(s)
- Faith G Davis
- Department of Public Health Sciences, School of Public Health, University of Alberta, Alberta, Canada.
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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.
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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
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Multidrug resistance gene (MDR-1) and risk of brain metastasis in epithelial ovarian, fallopian tube, and peritoneal cancer. Am J Clin Oncol 2011; 34:488-93. [PMID: 20921883 DOI: 10.1097/coc.0b013e3181ec5f4b] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To evaluate risk factors that predict brain metastasis in epithelial ovarian, fallopian tube, and peritoneal cancer. METHODS All patients with FIGO stage I to IV who underwent initial cytoreductive surgery between January 1995 and January 2009 were evaluated. The tumor samples were evaluated for 7 markers including multidrug resistance gene (MDR-1), DNA aneuploidity and S-phase fraction, human epidermal growth factor receptor 2, estrogen receptor, progesterone receptor, p53 mutation, epidermal growth factor receptor, and CD31. Biomarker expression was evaluated as a predictor of hematogenous metastasis to the following locations: (i) liver and spleen, (ii) lung, and (iii) brain. RESULTS There were 309 cases identified during the period. Of those, 5 (1.6%, 95% CI: 0.2%-3.0%) women developed brain metastasis. Time to onset of brain metastasis was significantly longer than that for other recurrent sites (median time to recurrence after initial cytoreduction, brain vs. lung vs. liver, 21.4 vs. 12.6 vs. 11.0 months, P< 0.05). Significantly increased expression of MDR-1 was seen in tumors from women who developed brain metastasis (brain vs. nonbrain sites, 80% vs. 4.2%-24.3%, P= 0.004). In multivariate analysis, MDR-1 was the only significant variable associated with the risk of brain metastasis. MDR-1 expression predicted brain metastasis (receiver-operator-characteristic curve analysis, AUC 0.808, P= 0.018), and with a 10% positive expression of MDR-1 as the cutoff value, sensitivity, specificity, positive predictive value, negative predictive value, accuracy of prediction of brain metastasis were 80%, 86.1%, 15.4%, 99.3%, and 85.9%, respectively (odds ratio: 24.7, 95% CI: 2.64-232, P= 0.002). CONCLUSIONS Increased expression of MDR-1 in the tumor tissue obtained at initial cytoreduction is associated with increased risk of developing brain metastases in women with epithelial ovarian, fallopian tube, or peritoneal cancer.
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Weston CL, Glantz MJ, Connor JR. Detection of cancer cells in the cerebrospinal fluid: current methods and future directions. Fluids Barriers CNS 2011; 8:14. [PMID: 21371327 PMCID: PMC3059292 DOI: 10.1186/2045-8118-8-14] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 03/03/2011] [Indexed: 12/25/2022] Open
Abstract
The spread of cancer into the central nervous system is a serious problem leading to neurological symptoms and rapid mortality. The current tools available for detecting the spread of cancer into the cerebrospinal fluid (CSF) are cytology, neurologic examination, and neuroimaging. All three of these methods can be applied in concert to reach a diagnosis, but they all suffer from a lack of sensitivity, leading to delays in treatment in many cases. An overview of research tools in the field of CSF cancer detection reveals a variety of promising technologies that can be used to answer questions about the biology of metastatic cancer and to develop more powerful clinical detection methods. Methods currently under investigation include new immunocytochemistry methods and flow cytometry for the in vitro detection of cells. Additionally, polymerase chain reaction, fluorescence in situ hybridization, capillary electrophoresis with laser-induced fluorescence, and mass spectrometry using matrix-assisted laser absorption-deionization time-of-flight and surface-enhanced laser desorption/ionization time-of-flight techniques are being tested for in vitro assessment of the non-cellular biomarkers in CSF. For in vivo detection of cancer in the CSF, research techniques include certain quantum dot platforms as well as magnetic iron oxide nanoparticles. As systemic therapies for cancer improve, the CNS is becoming a more common site of disease recurrence. This increases the importance of effective detection methods in the CSF, since early intervention can maximize therapeutic benefit. Furthermore, many cell-based detection methods can be combined with therapeutic agents to serve multiple medical functions through a common targeting system.
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Affiliation(s)
- Cody L Weston
- Department of Neurosurgery (H110), Penn State University M,S, Hershey Medical Center, 500 University Dr,, Hershey, PA, 17033-0850, USA.
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CHEN YL, CHENG WF, HSIEH CY, CHEN CA. Brain metastasis as a late manifestation of ovarian carcinoma. Eur J Cancer Care (Engl) 2010; 20:44-9. [DOI: 10.1111/j.1365-2354.2009.01133.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rauh-Hain JA, del Carmen M, Horowitz NS, Alarcon IA, Ko E, Goodman AK, Olawaiye AB. Impact of bowel obstruction at the time of initial presentation in women with ovarian cancer. BJOG 2009; 117:32-8. [DOI: 10.1111/j.1471-0528.2009.02416.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Ratner ES, Toy E, O'Malley DM, McAlpine J, Rutherford TJ, Azodi M, Higgins SA, Schwartz PE. Brain Metastases in Epithelial Ovarian and Primary Peritoneal Carcinoma. Int J Gynecol Cancer 2009; 19:856-9. [DOI: 10.1111/igc.0b013e3181a83301] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Thomakos N, Galaal K, Georgopoulos G, Nagaraju L, Hemming D, Naik R. Choroidal eye metastases from (recurrent) primary peritoneal carcinoma: case report and review of the literature. INTERNATIONAL SEMINARS IN SURGICAL ONCOLOGY 2009; 6:3. [PMID: 19154601 PMCID: PMC2633273 DOI: 10.1186/1477-7800-6-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Accepted: 01/20/2009] [Indexed: 11/10/2022]
Abstract
BACKGROUND Choroidal metastases from gynaecological primary are extremely rare. There is no documented case in the literature of choroid metastasis in a patient with primary peritoneal carcinoma (PPC). METHODS & RESULTS We describe the first case of a 54-year-old woman with a history of borderline mucinous tumour who presented 17 months later with PPC and 21 months after with recurrent disease metastatic to the eye, and review pertinent literature. CONCLUSION High index of suspicion is warranted when patients with history of primary peritoneal carcinoma present with visual complaints in order to treat and/or relieve symptomatology from metastatic eye disease.
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Affiliation(s)
- Nikolaos Thomakos
- Northern Gynaecological Oncology Centre, Gateshead Health NHS Trust, Queen Elizabeth Hospital, Sheriff Hill Gateshead NE9 6SX, UK.
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Monaco E, Kondziolka D, Mongia S, Niranjan A, Flickinger JC, Lunsford LD. Management of brain metastases from ovarian and endometrial carcinoma with stereotactic radiosurgery. Cancer 2008; 113:2610-4. [PMID: 18780313 DOI: 10.1002/cncr.23868] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Metastases to the brain from ovarian and endometrial carcinoma are uncommon and to the authors' knowledge consensus regarding optimal management is lacking. Stereotactic radiosurgery (SRS) has proven useful for the treatment of many benign and malignant brain tumors. In the current study, the authors evaluated outcomes after SRS in patients with ovarian and endometrial carcinoma. METHODS Twenty-seven patients with brain metastases underwent gamma-knife SRS. Six patients had endometrial carcinoma, whereas 21 patients had ovarian carcinoma. Eighteen patients also received whole-brain radiotherapy. A total of 68 tumors were treated with gamma-knife SRS. RESULTS At the time of last follow-up, 1 patient was still alive and 26 had died. The median survival was 7 months after the initial diagnosis of brain metastasis and 5 months after SRS. The 1-year survival rate after radiosurgery was 15% and that from the diagnosis of brain metastases was 22%. On final imaging, all tumors were controlled without further growth. Two patients (7.4%) developed new or progressive neurologic deficits after SRS. CONCLUSIONS SRS is an acceptable choice for the treatment of brain metastases resulting from ovarian and endometrial carcinoma, and provides local tumor control with limited morbidity. Careful patient selection is warranted in the setting of patients with uncontrolled systemic disease in whom a limited survival benefit is expected.
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Affiliation(s)
- Edward Monaco
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA
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OGAWA K, YOSHII Y, AOKI Y, NAGAI Y, TSUCHIDA Y, TOITA T, KAKINOHANA Y, TAMAKI W, IRAHA S, ADACHI G, HIRAKAWA M, KAMIYAMA K, INAMINE M, HYODO A, MURAYAMA S. Treatment and Prognosis of Brain Metastases From Gynecological Cancers. Neurol Med Chir (Tokyo) 2008; 48:57-62; discussion 62-3. [DOI: 10.2176/nmc.48.57] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kazuhiko OGAWA
- Department of Radiology, University of the Ryukyus School of Medicine
| | - Yoshihiko YOSHII
- Department of Neurosurgery, University of the Ryukyus School of Medicine
| | - Yoichi AOKI
- Department of Obstetrics and Gynecology, University of the Ryukyus School of Medicine
| | - Yutaka NAGAI
- Department of Obstetrics and Gynecology, University of the Ryukyus School of Medicine
| | - Yukihiro TSUCHIDA
- Department of Neurosurgery, University of the Ryukyus School of Medicine
| | - Takafumi TOITA
- Department of Radiology, University of the Ryukyus School of Medicine
| | | | - Wakana TAMAKI
- Department of Radiology, University of the Ryukyus School of Medicine
| | - Shiro IRAHA
- Department of Radiology, University of the Ryukyus School of Medicine
| | - Genki ADACHI
- Department of Radiology, University of the Ryukyus School of Medicine
| | - Makoto HIRAKAWA
- Department of Obstetrics and Gynecology, University of the Ryukyus School of Medicine
| | - Kazuya KAMIYAMA
- Department of Obstetrics and Gynecology, University of the Ryukyus School of Medicine
| | - Morihiko INAMINE
- Department of Obstetrics and Gynecology, University of the Ryukyus School of Medicine
| | - Akio HYODO
- Department of Neurosurgery, University of the Ryukyus School of Medicine
| | - Sadayuki MURAYAMA
- Department of Radiology, University of the Ryukyus School of Medicine
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Pectasides D, Pectasides M, Economopoulos T. Brain Metastases from Epithelial Ovarian Cancer: A Review of the Literature. Oncologist 2006; 11:252-60. [PMID: 16549809 DOI: 10.1634/theoncologist.11-3-252] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Brain metastases from epithelial ovarian cancer (EOC) are rare. This report is based on a review of the literature. METHODS AND RESULTS This review summarizes the incidence, clinical features, pathophysiology, and diagnostic evaluation of EOC. The section on current treatment includes a thorough evaluation of the literature, highlights controversies over treatment options, and provides insight into novel approaches. Current treatment options include surgical resection, whole-brain radiation therapy (WBRT), stereotactic radiosurgery, and chemotherapy. Corticosteroids and anticonvulsant medications are commonly used for the palliation of mass effects and seizures, respectively. In the reviewed series, a better outcome was seen following surgical resection and WBRT with or without chemotherapy for solitary and resectable brain metastases. CONCLUSION The prognosis for patients with brain metastases from EOC is poor. A better outcome might be obtained using multimodality therapy. Because of the small number of patients included in the reported studies, multicenter clinical trials are needed for further investigation in order to critically evaluate the clear benefit of these treatment options in selected patients.
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Affiliation(s)
- Dimitrios Pectasides
- Second Department of Internal Medicine, Propaedeutic, Oncology Section, Attikon University Hospital, 1 Rimini St, Haidari, Athens, Greece.
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Chen PG, Lee SY, Barnett GH, Vogelbaum MA, Saxton JP, Fleming PA, Suh JH. Use of the Radiation Therapy Oncology Group recursive partitioning analysis classification system and predictors of survival in 19 women with brain metastases from ovarian carcinoma. Cancer 2005; 104:2174-80. [PMID: 16208705 DOI: 10.1002/cncr.21472] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Brain metastases are an uncommon complication in women with primary ovarian carcinoma; thus, little is known about whether the Radiation Therapy Oncology Group (RTOG) recursive partitioning analysis (RPA) prognostic classification system is valid in this patient population. METHODS From September 1985 to June 2002, 19 patients with brain metastases resulting from primary ovarian carcinoma underwent treatment at the Cleveland Clinic Foundation. The medical records of these patients were retrospectively reviewed. RESULTS At the time of data analysis, all 19 women had died. The median age at diagnosis of primary ovarian carcinoma and brain metastasis was 51 and 54 years of age, respectively. Fifteen patients presented with a Karnofsky performance status (KPS) of 70 or higher. Seven patients had a single brain lesion and 12 had multiple lesions. All RTOG RPA prognostic classes were represented, with median survivals of 24.7, 8.9, and 2.6 months for Classes I, II, and III, respectively (P = 0.31). Patients who underwent surgical resection survived longer than those who did not (33.7 vs. 7.4 mos). The presence of multiple lesions was adversely related to survival on multivariate analysis (P = 0.03). Primary control was an important predictor of survival on multivariate analysis as well (P = 0.01) and was achieved in 15 of the 19 women. CONCLUSIONS This is the first study to support the prognostic usefulness of the RTOG RPA classification for ovarian carcinoma patients with metastasis to the brain. The number of metastatic intracranial lesions should be included when determining the prognosis.
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Affiliation(s)
- Philip G Chen
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Abstract
Metastases are the most common tumors of the central nervous system (CNS), but cancer databases are often incomplete leading to underestimation of the incidence of even symptomatic brain metastases. Brain imaging studies are not routinely performed on neurologically asymptomatic cancer patients and autopsy studies are outdated. Furthermore, while incidence rates for cancers are stable and mortality is decreasing due to earlier detection and better therapy, the incidence of brain metastases appears to be increasing. The pathophysiology of brain metastases is a complex multistage process, mediated by molecular mechanisms; from the primary organ, cancer cells must transform, grow and be transported to the CNS where they can lay dormant for various lengths of time before invading and growing further. Understanding the pathophysiology of brain metastases is of great importance, because it may lead to the development of more efficient therapies to combat brain tumor growth or to possibly make the CNS an undesirable environment for tumor progression.
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Affiliation(s)
- Igor T Gavrilovic
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
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Leroy-Dudal J, Demeilliers C, Gallet O, Pauthe E, Dutoit S, Agniel R, Gauduchon P, Carreiras F. Transmigration of human ovarian adenocarcinoma cells through endothelial extracellular matrix involves alphav integrins and the participation of MMP2. Int J Cancer 2005; 114:531-43. [PMID: 15609323 DOI: 10.1002/ijc.20778] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The growth of ovarian carcinoma is dependent upon their vascularistion, but the interaction of ovarian cancer cells with the endothelium and their invasion through an endothelial environment remain poorly understood at the molecular level. To investigate adhesive events underlying this process with focusing on the role of alphav integrins and MT1MMP-MMP2 proteinases, we used in vitro models of cocultures of human ovarian adenocarcinoma cell lines (IGROV1 and SKOV3) with human umbilical vein endothelial cells (HUVECs). Immunostaining of HUVECs revealed the network organisation of fibrillar fibronectin (Fn) and pericellular vitronectin (Vn). During coculture, IGROV1 and SKOV3 cells gain access to subendothelial basement membrane of HUVECs and dislocated endothelial Fn without affecting endothelial Vn. Transmigration assays revealed that tumour cells invade Vn and, with an higher efficiency, Fn. Our data also highlighted that ovarian carcinoma cells migrated through the Fn-rich HUVEC-ECM. The expression of MMP2 and MT1-MMP was revealed in tumour cells within an endothelial environment. Furthermore, we found that cell migration through the endothelial ECM was almost totally dependent on alphav integrin function, whereas beta1 integrins were not solicited. In addition, inhibitors of MMP2 activity (alone or combined with anti-alphav integrin MAb) or TSRI265 (which blocks MMP2-alphavbeta3 association) were found to impede this process. Finally, alphav integrins, MT1-MMP and MMP2 were found in ovarian carcinoma cells within the 3-dimensional architecture of intraperitoneal tumour nodes collected from nude mice xenografted with IGROV1 or SKOV3 cell lines or within human tumour tissues. alphav integrins therefore appear as essential to the migration properties of human ovarian carcinoma cells, especially in an endothelial environment, with MMP2 participating to this process.
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Melichar B, Urminská H, Kohlová T, Nová M, Cesák T. Brain metastases of epithelial ovarian carcinoma responding to cisplatin and gemcitabine combination chemotherapy: a case report and review of the literature. Gynecol Oncol 2004; 94:267-76. [PMID: 15297161 DOI: 10.1016/j.ygyno.2004.05.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2004] [Indexed: 11/22/2022]
Abstract
BACKGROUND Brain represents a rare site of metastasis in patients with epithelial ovarian carcinoma (EOC). CASE REPORT We observed a case of multiple brain metastases in an EOC patient after complete response of a pelvic recurrence to platinum/paclitaxel chemotherapy. Complete response of brain metastases was observed after whole brain radiotherapy and subsequent chemotherapy by combination of cisplatin and gemcitabine. Three subsequent recurrences of brain metastases were controlled by re-treatment by the combination of 5-fluorouracil, cisplatin and gemcitabine. METHODS Because of limited information on the outcome of EOC brain metastases in reported case series, a pooled analysis of the published reports in patients with EOC brain metastases was performed. Data were extracted from 46 reports that contained sufficient details on 189 individual patients. The survival was analyzed by the Kaplan-Meier method. Univariate and multivariate analyses were performed by the log-rank test and Cox method, respectively. RESULTS The most favorable outcome was observed in patients treated by surgery combined with radiotherapy and/or chemotherapy. The survival was significantly better in reports describing only one or two cases, in patients diagnosed after 1992, in patients who received therapy in addition to symptomatic treatment, in patients treated by radiotherapy, chemotherapy and surgery, in patients without extracranial metastases and with single brain metastases. On multivariate analysis, the absence of extracranial metastases, treatment by chemotherapy, surgery and radiotherapy were independent positive predictors of survival. CONCLUSIONS EOC brain metastases are responsive to chemotherapy. An aggressive multidisciplinary therapeutic approach including chemotherapy may lead to prolonged survival.
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Affiliation(s)
- Bohuslav Melichar
- Department of Radiology, Charles University Medical School Teaching Hospital, Sokolská 581, 500 05 Hradec Králové, Czech Republic.
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Kumar L, Barge S, Mahapatra AK, Thulkar S, Rath GK, Kumar S, Mishra R, Dawar R, Singh R. Central nervous system metastases from primary epithelial ovarian cancer. Cancer Control 2003; 10:244-53. [PMID: 12794622 DOI: 10.1177/107327480301000309] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Lalit Kumar
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
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