Oct 23, 2011 - 9:11 pm
[This was requested by california artist to also be posted in the uterine board]
Brain metastases commonly develop among patients with ovarian cancer, and do so rapidly in those with advanced disease, a retrospective review found.
In a study of 78 women with ovarian cancer who developed one or more brain metastases, 50% developed a single metastasis, according to Sewit Teckie, MD, and colleagues from Memorial Sloan-Kettering Cancer Center in New York.
In addition to that group, another 19% of patients were found to have two or three metastases on initial diagnosis, 23% had four or more, and 8% already had leptomeningeal disease, Teckie told MedPage Today during a poster session at the annual meeting of the American Society for Radiation Oncology (ASTRO).
The patients were treated at the cancer center between 1983 and 2010. Their median age was 54.8 and 88% had stage III/IV disease.
The location of the metastases was the cerebral hemisphere in 56%, the cerebellum in 15%, and both in 28%.
Median overall survival was 62.3 months (95% CI 51.2 to 73.3).
The median time after diagnosis to the detection of brain metastasis was 71.1 months in patients with early-stage disease and 38.3 months when disease was diagnosed at stage III/IV.
Median follow-up for the entire cohort was eight months, and for the six patients still alive at the time of this analysis, median follow-up was 15 months.
Among all patients who developed the metastases, median subsequent survival was 8.9 months (95% CI 5.5 to 15.3), with a median survival of 14 months (95% CI 7.7 to 27.9) specifically in those who had only one metastasis.
A total of 92% of patients received whole- or partial-brain radiation therapy or stereotactic radiosurgery for their metastatic disease, while 49% had surgical treatment.
Most of those who had surgery had only one brain metastasis.
A total of 25 patients who underwent surgery also had postoperative radiation, and 15 required salvage radiation after local treatment was unsuccessful.
On multivariate analysis, these factors were associated with poor survival:
Karnofsky performance status ≥70, HR 0.35 (P=0.004)
Among 33 of 39 patients for whom follow-up imaging was available, progressive or recurrent metastatic disease had occurred and 20.5% had developed leptomeningeal disease.
Six of those patients had an initial partial or complete response to radiotherapy, but two had later recurrences.
Median survival after radiation therapy for leptomeningeal disease was four months, although one patient remained alive after one year.
"More cases of leptomeningeal disease are being reported. These patients did better than patients usually do," Teckie said. "We knew leptomeningeal disease was a poor predictor, but this has not previously been analyzed statistically," she added.
In general, although brain metastases occur earlier in advanced ovarian cancer, if only one metastasis is present, stereotactic radiosurgery or surgery plus radiation therapy can provide a durable response and improve survival for some patients, she concluded.
Primary source: American Society for Radiation Oncology ASTRO 2011; Abstract 2568.
Source reference: Teckie S, et al "Predictors of survival in ovarian cancer brain metastases" ASTRO 2011; Abstract 2568.