Radiation therapy for epithelial ovarian cancer brain metastases: clinical outcomes and predictors of survival

Sewit Teckie,Kathryn Beal,Viviane Tabar,Martee Hensley,Kaled Alektiar,Carol Aghajanian,Vicky Makker

doi:10.1186/1748-717x-8-36

Sewit Teckie, Kathryn Beal + Show 5 more

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https://doi.org/10.1186/1748-717x-8-36

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Abstract

BackgroundBrain metastases (BM) and leptomeningeal disease (LMD) are uncommon in epithelial ovarian cancer (EOC). We investigate the outcomes of modern radiation therapy (RT) as a primary treatment modality in patients with EOC BM and LMD.MethodsWe evaluated 60 patients with EOC treated at our institution from 1996 to 2010 who developed BM. All information was obtained from chart review.ResultsAt EOC diagnosis, median age was 56.1 years and 88% of patients were stage III-IV. At time of BM diagnosis, 46.7% of patients had 1 BM, 16.7% had two to three, 26.7% had four or more, and 10% had LMD. Median follow-up after BM was 9.3 months (range, 0.3-82.3). All patients received RT, and 37% had surgical resection. LMD occurred in the primary or recurrent setting in 12 patients (20%), 9 of whom received RT. Median overall survival (OS) after BM was 9.7 months for all patients (95% CI 5.9–13.5), and 16.1 months (95% CI 3.8-28.3) in patients with one BM. On multivariate analysis, Karnofsky performance status less than 70 (hazard ratio [HR] 2.86, p = 0.018), four or more BM (HR 3.18, p = 0.05), LMD (HR 8.22, p = 0.013), and uncontrolled primary tumor (HR 2.84, p = 0.008) were significantly associated with inferior OS. Use of surgery was not significant (p = 0.31). Median central nervous system freedom from progression (CNS-FFP) in 47 patients with follow-up was 18.5 months (95% CI, 9.3–27.9). Only four or more BM (HR 2.56, p = 0.04) was significantly associated with poorer CNS-FFP.ConclusionsBased on our results, RT appears to be an effective treatment modality for brain metastases from EOC and should be routinely offered. Karnofsky performance status less than 70, four or more BM, LMD, and uncontrolled primary tumor predict for worse survival after RT for EOC BM. Whether RT is superior to surgery or chemotherapy for EOC BM remains to be seen in a larger cohort.

Highlights

Brain metastases (BM) and leptomeningeal disease (LMD) are uncommon in epithelial ovarian cancer (EOC)
On MVA for Central nervous system (CNS)-Freedom from progression (FFP), only four or more BM remained significant (HR, 2.56; p = 0.04), Discussion Our series represents the largest in the published literature of radiation therapy (RT) for treatment of BM in EOC, with a total of 60 patients analyzed. We show that these patients can be effectively treated with RT, with or without resection of tumor, and that survival in these patients depends on Karnofsky Performance Status (KPS), number of BM, presence of LMD, and presence of uncontrolled primary tumor
This study is the largest reported series of patients with EOC BM treated with modern radiation therapy

Summary

Introduction

Brain metastases (BM) and leptomeningeal disease (LMD) are uncommon in epithelial ovarian cancer (EOC). We investigate the outcomes of modern radiation therapy (RT) as a primary treatment modality in patients with EOC BM and LMD. No studies investigate the impact of modern radiation therapy (RT) as a primary treatment modality in these patients. Median survival in existing studies of EOC with BM has generally been poor, on the order of several months, but some studies report survival as high as 18–33 months in selected patients treated with multimodality therapy that combines surgery, radiation therapy, and systemic chemotherapy [3,5,13,14]. Prior studies of BM in advanced malignancies and in small series of EOC have found performance status, age, primary tumor control, extracranial metastases, and treatment modality for BM to be predictors of survival after BM [4,11,12,15,16].

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