BMET-21. USE OF TUMOR TREATING FIELDS IN BRAIN METASTASES FROM OVARIAN CANCER, A CASE REPORT

Abstract

Ovarian cancer is the most common gynecologic cancer in United States. Central nervous system (CNS) metastases from ovarian cancer are uncommon, occurring in about 4% cases. Factors associated with increased survival are younger age, lower tumor grade, higher performance status and multimodality treatment. Standard treatment approaches include surgical resection, stereotactic radiosurgery, local radiation and medical therapy. 47 year old Caucasian woman with past medical history of hypertension presented with abdominal bloating and was diagnosed with adenocarcinoma of the ovary (stage IIIC). Neoadjuvant chemotherapy with carboplatin/paclitaxel was followed by total abdominal hysterectomy, bilateral salpingo-oophorectomy with sigmoid colectomy. Optimal debulking of her ovarian adenocarcinoma was followed by adjuvant carboplatin/paclitaxel x 1 cycle and 3 cycles of intravenous/intraperitoneal cisplatin/paclitaxel. She had no evidence of disease for over a year since initial diagnosis, but then presented with difficulty finding words. Magnetic Resonance Imaging of the brain showed over 30 intra-axial enhancing masses throughout both cerebral and cerebellar hemispheres, largest lesion measured 2.5 x 2.1 x 2.3 cm. She was started on dexamethasone and levetiracetam and was treated with whole brain radiation therapy, 30Gy in 10 fractions with some response. She was not a candidate for systemic therapy trials and was treated with continuous tumor treating fields (TTF) via the Optune device. She tolerated the treatment well and was able to taper off the steroids. She has been using the device for 5 months and has shown positive clinical and radiologic response to therapy. Use of TTFs for the treatment of brain metastases from ovarian cancer was feasible and well tolerated in this patient. This is the first case of TTF in brain metastases from ovarian cancer and showed good response with improved clinical and radiologic findings and should be further evaluated for this indication.