Brain metastases as isolated site of relapse in patients with epithelial ovarian cancer previously treated with platinum and paclitaxel-based chemotherapy

Abstract

Brain metastases in patients with epithelial ovarian cancer (EOC) have an estimated incidence of 0.3-1.9% and are isolated in up to 50% of these patients. The risk factors and the prognostic significance of isolated central nervous system (CNS) relapse in patients with EOC who received primary treatment with platinum and paclitaxel have not been identified. We conducted a retrospective study in patients with EOC who relapsed with isolated brain metastases and report our experience. Two hundred sixty-seven patients with stages III and IV EOC, in clinical complete remission after first-line treatment with platinum and paclitaxel, were included in our analysis. After a median follow-up of 65 months, 150 patients had relapsed. Eight patients (5%) had isolated brain metastases. Patient and disease characteristics did not differ among patients who relapsed with isolated brain metastases and those with relapse outside the CNS. Median time to first disease relapse, overall survival, and survival after relapse did not differ significantly between patients with brain metastases and those with relapse outside the CNS. Two patients have died 6 and 12 months after the diagnosis of brain metastases, and 5 patients are alive 4-35 months after the diagnosis of isolated brain metastases. Three patients remain free of disease 4-18 months after treatment with radiotherapy and systemic chemotherapy for their CNS metastatic disease. Patients with isolated brain metastases have comparable survival to patients with relapse outside the CNS, and long-term remission can be achieved in some cases, provided that systemic chemotherapy is added to local treatment.

Central Nervous System Metastases From Epithelial Ovarian Cancer

“…Several authors concluded that CHT should be added to the local therapy for the brain metastases to obtain an effective increase of survival because most of these patients have the cancer spread outside the CNS. 5,11,20,21 The best results were obtained with carboplatin, 22 cisplatin plus gemcitabine, 13 and carboplatin plus docetaxel. 23 Although the role of the different therapeutic approaches is still on debate, many authors agree that the best management is, in any case, a multimodal treatment, to have both a local and systemic control of the widespread of this aggressive disease 5,12,14,20,21,24 ; this also is confirmed in our series as shown in Figure 2.…”

Metastases to the brain and to the skull base of carcinomas that are rarely metastasize to the central nervous system. Clinical and morphological analysis of 51 cases and literature review

“…В той серии рецидивы в среднем через 19 месяцев возник-ли у 87% пациентов. Частота возникновения МГМ при раке яичников составляет 0.3-1.9% [8,11]. В другой серии лишь 8 пациентов с ра-ком яичников 3 и 4 стадии в последствие име-ли МГМ, при этом обнаружено, что агрессив-ная химиотерапия является фактором риска развития МГМ [11].…”

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.…”