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.
Highlights
Brain metastasis (BM) is a rare event in ovarian cancer patients
We evaluated prognostic factors in a cohort of ovarian cancer patients who presented with BM, considering the specific characteristics of ovarian cancer treatment and its natural history
The median age at the diagnosis of BM was 63.0 years, and the median time from the primary diagnosis to BM was 31.7 months; most patients presented with high-grade serous carcinoma and had a negative family history for breast or ovarian cancer and an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 (Table 1)
Summary
Brain 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. Ovarian cancer is the eighth most frequent cancer among women, amounting to 295,414 cases worldwide in 2018 [1]. It is the most lethal gynecological cancer, accounting for 2.5% of female malignancies but 5.0% of deaths due to cancer in women [2]. Brain metastasis (BM) is an uncommon event in ovarian cancer patients and is estimated to occur in 0.3 to 12% of patients, depending on the series. The response to systemic treatment including chemotherapy or targeted therapy in the BM seems to parallel the response of the primary tumor [4]
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