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

Radiation Oncology

Kathryn Beal²  Martee Hensley¹  Carol Aghajanian¹  Kaled Alektiar²  Viviane Tabar³  Vicky Makker¹  Sewit Teckie² 

[1] Department of Medicine, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, 1275 York Avenue, New York, NY, USA;Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, USA;Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, USA

关键词: Palliation;    Leptomeningeal disease;    Brain metastases;    Ovarian cancer;   

Others  :  1154578
DOI  :  10.1186/1748-717X-8-36

 received in 2012-08-24, accepted in 2013-02-09,  发布年份 2013

【 摘 要 】

Background

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.

Methods

We evaluated 60 patients with EOC treated at our institution from 1996 to 2010 who developed BM. All information was obtained from chart review.

Results

At 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.

Conclusions

Based 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.

【 授权许可】

   
2013 Teckie et al.; licensee BioMed Central Ltd.

【 图 表 】

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