Prognostic factors associated with brain metastases from epithelial ovarian carcinoma

Abstract

Brain metastasis from epithelial ovarian carcinoma (EOC) is managed by a multimodal treatment approach. Thus, to determine the prognostic factors associated with this situation is important for management decisions regarding the type of treatment and aggressiveness of treatment. From 1995 to 2005, 13 patients with brain metastases resulting from EOC underwent treatment at Samsung Medical Center. We retrospectively reviewed the medical records to determine prognostic factors and to evaluate treatment outcome. The median age at diagnosis for primary ovarian carcinoma and brain metastasis was 52 and 55 years, respectively. Median interval to brain metastases was 28 months after the diagnosis of EOC. At the time of analysis, nine patients had died of disease. The median survival from brain relapse was 7 months. A Karnofsky performance status of 70 or higher, primary control, solitary brain lesions, recursive partitioning analysis (RPA) class, and treatment modality including gamma-knife radiosurgery (GKRS) were related to survival on univariate analyses. Multivariate analysis showed that treatment modality including GKRS was a more important prognostic factor than RPA class (P = 0.04). This small series demonstrated that GKRS can be a valuable modality for the management of brain metastasis in patients with EOC. Therefore, a better outcome can be achieved by choosing GKRS in their treatments in selected patients.

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.…”

“…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.…”

Brain Metastases in a Patient with Ovarian Cancer

“…Traditionally, patients with solitary metastases have undergone metastasectomy and whole brain radiotherapy (WBRT) [25]. The latter is associated with a number of late complications, including brain atrophy, necrosis, dementia, and endocrine dysfunction [26].…”

“…Contrast-enhanced magnetic resonance imaging (MRI) is the most accurate modality to image the brain [25].…”