Central nervous system (CNS) metastasis is a rare event in ovarian cancer patients and current prognostic index used for other tumors do not fit for ovarian cancer patients with brain metastasis (BM). We sought to evaluate prognostic factors for overall survival (OS) in ovarian cancer patients with BM.
We retrospectively evaluated patients with diagnosis of ovarian carcinoma and BM treated at A.C. Camargo Cancer Center from January 2007 to December 2017. Clinical data from diagnosis and at the moment of diagnosis of BM were collected. OS was defined as the time from diagnosis of BM to the moment of death by any cause. OS was calculated using Kaplan Meier curves and log rank test was used to compare OS curves. Univariate cox regression was used to evaluate prognostic factors for OS.
From 560 patients 26 presented BM. Median age at diagnosis of BM was 62.9 years old, 23 patients had high grade serous carcinoma, 2 had high grade endometrial carcinoma and 1 carcinosarcoma. Recurrences in the brain were classified as platinum sensitive in 14 patients (53.8%) and platinum resistant in 11 patients (42.3%), ECOG performance status was 0 or 1 in sixteen patients. Fourteen patients (53.8%) had disease progression exclusively in the CNS. The median number of BM was 4, and medium size of the largest lesion was 3.2cm. Median time from initial diagnosis to BM was 31.7 months. Eight patients were treated with surgery, 15 with whole brain radiotherapy (RT), 5 with stereotaxic RT and 4 patients received systemic treatment at the moment of BM diagnosis. Median follow up was 18.7 months and median OS was 10.8 months. Factors associated to OS were as following: platinum sensitive recurrence (HR 0.34, CI95% 0.12-0.99; p = 0.049), higher number of previous treatment lines (HR 1.57, CI95% 1.12-2.19; p = 0.008), ECOG performance status (HR 2.52, CI95% 1.24-5.09; p = 0.010), and longer interval from initial diagnosis to BM (p = 0.025). Notably, number of brain metastasis, largest tumor size and progression outside CNS were not related to survival.
Factors related to sensitivity to platinum therapy and BM as early event during the course of disease seem to be more related to survival than factors usually related to survival in BM from other cancers.
Clinical trial identification
Legal entity responsible for the study
A.C. Camargo Cancer Center.
Has not received any funding.
All authors have declared no conflicts of interest.