Meningeal carcinomatosis from an ovarian primary with complete response to adjuvant chemotherapy after cranial irradiation

Abstract

Meningeal metastasis is rare in the clinical course of ovarian carcinoma, and its prognosis is poor. Meningeal dissemination of carcinoma is usually treated by intrathecal administration of methotrexate and total brain irradiation, although these treatments are usually ineffective. We experienced a case of meningeal relapse from ovarian carcinoma resistant to multiple antineoplastic agents in a 64-year-old woman who was treated with eight different chemotherapy regimens after her initial operation 7 years previously. Intrathecal administrations of methotrexate or cisplatin with dexamethasone were not effective. Fifty-Gy whole cranial irradiation inhibited increases in serum carbohydrate antigen (CA) 125 levels and further tumor growth. Adjuvant chemotherapy was required to alleviate frequent headaches and to decrease serum CA125 level and tumor size. Intravenous administration of 45 mg paclitaxel and 35 mg cisplatin, and oral administration of 50 mg etoposide were carried out for 5 days. This treatment was repeated every 3 weeks. After four courses of treatment, meningeal carcinomatosis was not detectable on computed tomography (CT) and magnetic resonance imaging (MRI) scans. The patient's serum levels of CA125 rapidly fell to beneath normal limits and remained normal. She is still alive and clinically free of recurrence 4 months after the last cycle of chemotherapy. As well as reporting our experience with this case, we also present a review of the literature on meningeal carcinomatosis from ovarian cancer.

Multiple cerebral and leptomeningeal metastases from ovarian carcinoma: unusual early presentation

“…9,10 Metastases have a preference for the parenchyma rather than the leptomeninges. 11,12,13 The initial clinical presentation by the patient in this report, with vague encephalopathic features, made the diagnosis unclear, but investigations confirmed multiple brain and leptomeningeal lesions with histopathology indicating metastasis. An ovarian tumour was subsequently identified.…”

Ovarian Small Cell Carcinoma Complicated by Carcinomatous Meningitis

“…3,7,16–19 The incidence of CM with ovarian cancer is 0.08–0.28%. 20 In Eichhorn's report on primary ovarian small cell carcinoma of the pulmonary type, 1 of the 11 patients (9%) had brain and spine metastases. 9 The median survival time of untreated patients with CM is 4–6 weeks.…”

Unusual Early Cerebral Metastasis of Ovarian Carcinoma as Initial Presentation

“…Only a few reported cases in the literature confirm early brain metastases as initial presentation and usually as a single lesion [9][10][11]. The ovarian metastases to brain have a predilection for the parenchyma rather than the leptomeninges [12][13][14]. As documented in this study the initial clinical presentation of ovarian carcinoma was neurological features.…”