Brain metastases from epithelial ovarian cancer

Abstract

Brain metastasis from epithelial ovarian cancer is uncommon. We studied the presentation, treatment, and prognosis of brain metastasis in a single institution. A retrospective review of clinical details kept in the computer database of gynecologic oncology services in a tertiary institution between 1993 and 2003 was done. A Medline search for English publications on brain metastasis from epithelial ovarian cancer was performed from 1966 to 2003. The study period included 605 patients, and 4 (0.66%) patients developed brain metastases. The patients were usually well, until they presented with hemiparesis. The median primary treatment to brain metastasis interval was 16.5 months. Three out of four cases had multiple brain metastases, and all had small-volume extracranial tumor relapses. Serum CA125 measurement was not reliable in the screening for brain metastasis. The median survival after brain metastasis was 19.5 months. Single brain metastasis can be treated with surgery. Our experience supports the prevalent published opinion that all other cases should be considered for combined radiotherapy and surgery or radiotherapy and chemotherapy. Surveillance of tumor recurrence with serum CA125 monitoring does not predict brain metastasis, which carries a poor prognosis. The best mode of management of these patients is yet to be determined. Large study with multicenter participation to establish the standard treatment is urgently needed.

Central Nervous System Involvement from Epithelial Ovarian Cancer

“…(Anupol, 2002;Brown III, 2005;Chen, 2009;Cohen, 2004;Cormio, 1995, 2003b, Cormio, 2011aD'Andrea, 2005;Kastritis, 2006;Kim, 2007;Kumar, 2003;Lee, 2008;Sanderson, 2002;Sehouli, 2010;Tay & Rajesh, 2005). However Kolomainen et al demonstrated in their series that a brain involvement could be seen quite frequently (one third of their patients) also in patients with FIGO stage I.…”

“…Although older studies suggested that these patients should undergone only palliative management, in the last 15 year's published studies many authors agree that a multi-modal treatment is the modality of choice in selected patients and can achieve a long-term remission and a better quality of life. (Anupol, 2002;Brown III, 2005;Chen, 2009;Cohen, 2004;Cormio, 1995;Cormio, 2003b;Cormio, 2011a;D'Andrea, 2005;Kastritis, 2006;Kim, 2007;Lee, 2008;Sanderson, 2002;Sehouli, 2010;Tay & Rajesh, 2005). An aggressive multimodal approach should be aimed both to cure local and systemic disease and leads to an improvement in duration and quality of life.…”

“…Other symptoms that are often described are vomiting, confusions, visual disturbances, paresis, and weakness, loss of consciousness, seizures, and dizziness. (Cohen, 2004;Cormio, 2011a;D'Andrea, 2005;Lee, 2008;Pectasides, 2006;Tay &Rajesh, 2005) The leptomeningeal involvement usually causes an arise of the intracranial pressure associated with hydrocephalus; these patients more frequently than the others complain also for bowel of bladder dysfunctions, while the involvement of cranial nerves can also be possible. (Pectasides, 2006;Vitaliani R, 2009) In our recent series of 20 patients, all patients were symptomatic at the moment of the diagnosis; most of them complain of headache, vomiting and dizziness with or without balance disturbances, less frequent symptoms were diplopia, convulsions, amnesia, confusion and pain.…”

“…In fact, while in 1995 the therapy was given more with palliative intent, nowadays clinicians are more likely to administer more aggressive and multimodal treatments, with the intent of both improving the quality of life and the overall survival. (Anupol, 2002;Brown III, 2005;Chen, 2009;Cohen, 2004;Cormio, 1995;Cormio, 2003b;Cormio, 2011a;D'Andrea, 2005;Kastritis, 2006;Kim, 2007;Lee, 2008;Sanderson, 2002;Sehouli, 2010;Tay & Rajesh, 2005) Future efforts can be put on one side, on the improvement of early diagnosis by the investigation of the role of new imaging techniques such as positron emission tomography and magnetic resonance spectroscopy in the detection of brain metastases, and on the other side on the improvement of treatment modality with higher efficacy and lower morbidity like the new radio surgical techniques. Although many authors agree that a multimodal approach results in better prognosis, further studies should be done to fix some guidelines for the treatment of these patients.…”

Treatment in patients with ovarian cancer metastasizing to the brain

“…-уже у 1,3% больных [9]. По данным ряда авторов [9][10][11][12][13][14][15][16][17][18][19][20][21][22], среди метастазов в головном мозге метастазы РЯ составляют от 0,2 до 11,6%. Причиной низкой встречаемости, вероятно, является от-носительно низкая способность серозного РЯ к гемато-генному метастазированию.…”