Prognostic impact of platinum sensitivity in ovarian carcinoma patients with brain metastasis

Abstract

BackgroundBrain metastasis (BM) is a rare event in ovarian cancer patients. The current prognostic scores that have been used for other tumors do not account for specific characteristics of ovarian cancer, such as platinum sensitivity.MethodsThis retrospective cohort study examined patients with ovarian carcinoma and BM who were treated at a single institution from January 2007 to December 2017. Clinical data on the diagnosis of BM and follow-up were collected. Cox regression was used to evaluate prognostic factors for overall survival (OS).ResultsOf 560 patients, 26 presented with BM. Eight patients were treated with surgery, 15 with whole-brain radiotherapy (RT), and 5 with stereotactic RT, and 4 patients received systemic treatment at the diagnosis of BM. The median OS was 10.8 months. The following factors were associated with OS: platinum-sensitive recurrence (HR 0.34, 95% CI 0.12–0.99; p = 0.049), higher number of previous treatment lines (HR 1.57, 95% CI 1.12–2.19; p = 0.008), ECOG performance status (HR 2.52, 95% CI 1.24–5.09; p = 0.010), and longer interval from initial diagnosis to BM (p = 0.025). Notably, the number of brain metastasis, the largest tumor size, and progression outside of the CNS were not related to survival. Platinum sensitivity was not associated with any of the classic prognostic factors in brain metastasis patients such as number or size of brain metastasis or disease progression outside the CNS strengthening the hypothesis of the importance of platinum sensitivity to the prognosis of ovarian cancer patients with BM.ConclusionsThe factors related to the biological behavior of the ovarian cancer such as platinum sensitivity at the time of BM diagnosis, fewer number of previous treatment lines and interval from initial diagnosis were associated with survival in ovarian cancer patients with BM, while factors that are usually related to survival in BM in other cancers were not associated with survival in this cohort of ovarian cancer patients. The small number of patients did not allow us to exclude the prognostic role of these former factors that were not associated with survival in the present cohort.

Ovarian serous carcinoma metastasis to the ventricular system: exceptional location report

“…This uncertainty is attributed to the blood-brain barrier, which restricts the delivery of large hydrophilic drugs to the brain, influencing the choice of agents and dosages. 18,19 Several studies suggested better tumor control with surgery combined with radiotherapy; whole brain radiotherapy or Gamma knife radiosurgery. 2,20,21 Stereotactic radiosurgery is typically recommended for patients with up to three cerebral lesions, allowing for high-dose radiation treatment in a single high dose radiation fraction.…”

Extraordinary Pattern with Brain Metastasis of Ovarian Cancer with Five Cases: Survival Impact of Cranial Metastesectomy. Do or Not To Do?

“…The average figure of 2.55% found in our literature review is consistent with the most recent post mortem review with the incidence of 2.1% (7 out of 340 cases). However, since most reports are from clinical studies and very few postmortem studies have been performed, it is possible that the actual incidence of brain metastasis from ovarian cancer is higher since brain imaging is not a routine component of follow up for patients with ovarian cancer to detect asymptomatic lesions [3,[8][9][10].…”

New treatment options for patients with brain metastases from ovarian cancer

“…Согласно данным литературы, большинство пациенток с РЯ, у которых развились церебральные метастазы, имели серозную аденокарциному высокой степени злокачественности, и 86 % пациенток имели распространенную стадию заболевания по FIGO (III-IV) на момент постановки диагноза [5]. Из общих характеристик таких больных можно выделить более молодой возраст (средний возраст на момент постановки диагноза -51 год) [7], высокий функциональный статус по шкале Карновского (KPS ≥70), чувствительность первичной опухоли к препаратам платины [8,9]. В то же время ряд авторов подчеркивают, что проявление экстракраниального рецидива не всегда ухудшает выживаемость таких больных [10], а пациентки с наличием мутации в генах, продукты которых участвуют в процессе репарации ДНК путем гомологичной рекомбинации (HRD), в частности BRCA1 и BRCA2, демонстрируют более высокую выживаемость [11].…”