Brain Metastases in Patients with Gynecologic Cancers: A Single Institution Experience and Review of the Literature (original) (raw)
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Brain Metastases From Gynecologic Malignancies
American Journal of Clinical Oncology, 2020
Objective: The objective of this study was to investigate the prevalence, clinicopathologic characteristics, management, and outcomes of patients with brain metastasis (BM) from gynecologic malignancies in a large hospital-based database. Materials and Methods: The National Cancer Database (NCDB) was accessed and patients with ovarian, uterine, or cervical cancer and BM were identified. We identified those who received radiation therapy (RT) as whole-brain radiation therapy (WBRT) or stereotactic radiosurgery (SRS). Kaplan-Meier curves were generated to determine median overall survival (OS) and compared with the log-rank test. Results: A total of 853 patients with BM were identified. The rate of BMs upon diagnosis was 0.4% (211/57,160) for patients with cervical cancer, 0.2% (498/243,785) for patients with uterine, and 0.2% (144/92,301) for ovarian malignancies. Only 30.4% had isolated BM, while 52.2% had lung metastasis. Approximately half of the patients (50.1%) received chemotherapy, while brain RT was administered to 324 (38%) patients. Among patients who received brain RT, only 60 (18.5%) had SRS, while 264 (81.5%) had WBRT. Patients who underwent SRS had a better survival (n = 47, median OS = 9 mo) than those who received WBRT (n = 201, median OS = 4.73 mo, P = 0.018), or those who did not receive any brain RT (n = 370, median OS = 4.01 mo, P = 0.007). Conclusions: The incidence of BM among patients with gynecologic malignancies is rare and associated with poor survival. For select patients, SRS may be associated with prolonged survival.
2012
To present 12 gynecologic cancer cases with brain metastasis and a discussion of the relevant literature. Gynecologic malignancy is the second most common cancer in elderly women, following breast cancer. Th ese cancers usually spread locally at fi rst, and common distant metastatic sites are the lungs, liver, spleen, and distant lymph nodes. Th e brain is not a usual site of metastatic involvement. Materials and methods: Th e study included 12 cases with various gynecologic malignancies that were retrospectively analyzed. Th erapeutic modalities, survival, and time between initial surgery and brain metastasis were recorded. Results: Th e mean survival was 41.4 months in 6 patients with ovarian cancer versus 27.7 months in those with other gynecological cancers. At the time of brain metastasis, the CA-125 level was elevated in all of the patients, except one that had cervical cancer. Th e mean CA-125 level was 202 IU mL-1. Th ere were no diff erences in the mean overall survival between the patients that underwent surgical resection and those that received medical treatment. Conclusion: Brain metastasis can occur in all gynecologic cancers and has a poor prognosis, despite multimodal treatment.
Brain metastases from gynecological cancers: factors that affect overall survival
Technology in cancer research & treatment, 2002
We retrospectively reviewed factors that affected overall survival for patients with gynecological cancers that had metastasized to the brain. Between January 1985 to November 1999, we treated 25 patients with brain metastases from gynecological malignancies (cervix n=6, endometrium n=10, and ovary n=9). Various patient and tumor characteristics were identified and analyzed for their significance. Median age was 46 years old (range, 37-78 years) with the majority of tumors being adenocarcinoma (20/25 patients). The treatment consisted of whole brain radiation therapy (WBRT) in 11 patients, focal therapy (surgery and/or stereotactic radiosurgery [SRS]) in 6 patients, and combination therapy (WBRT and surgery and/or SRS) in 8 patients and resulted in median survivals of 6 months, 7 months and 11 months, respectively. Overall median survival was 7.3 months (range, 1 to 88 months). Cause of death was systemic in 9, neurologic in 8 and progression of primary in 2. Those with single lesio...
Managing Brain Lesions in Gynecological Cancers: A Case Series
Indian Journal of Gynecologic Oncology, 2020
Background Brain metastasis in recurrent setting is a rare phenomenon in gynecological cancers. Even rarer is the occurrence of second intracranial primary. All these women generally will present with subtle neurological symptoms. However due to its rarity and non-specificity of symptoms, these often tend to get missed. Method and results Here we present a case series of six women of known gynecological cancers who presented to our department with brain space occupying lesions (SOLs). Five among these were primary ovarian cancers who had recurred with brain metastasis. The sixth one was a case of endometrial cancer treated in the past for recurrence and now presenting with a second primary. MRI brain was used to confirm diagnosis in all of them. Two were inoperable disease due to diffused parenchymal brain metastasis. They received palliative care and died subsequently. Four were initially managed with surgical resection with uneventful postoperative outcome. This was followed by adjuvant treatment in the form of whole brain radiotherapy (WBRT) with or without chemotherapy. Three of them successfully completed their adjuvant treatment and kept on follow-up whereas the fourth progressed on treatment. Their long-term outcomes are yet to be seen. Conclusion Selected cases with brain metastasis merits aggressive approach with surgical removal of tumor followed by adjuvant treatment.
in Vivo, 2018
Background/Aim: Personalization of the treatment of brain metastases considering patient's overall survival (OS) prognosis is gaining importance. This study was conducted to develop an OS score particularly for patients receiving local therapies for single brain metastasis from gynecological malignancies. Patients and Methods: In 11 patients, the following factors were retrospectively analyzed for associations with OS: Age, Karnofsky performance score (KPS), tumor type, extra-cranial metastatic sites, and time from diagnosis of gynecological malignancy to treatment of brain metastasis. Factors showing at least a strong trend were used for the score. Results: A KPS of 80-90% resulted in a significantly better OS than a KPS of 50-70% (p=0.008). Absence of extra-cranial metastases showed a strong trend (p=0.052). For the score, the following points were used: KPS 50-70%=0, KPS 80-90%=1, presence of extra-cranial metastatic sites=0, absence=1. Patients' scores were 0, 1 or 2 points. OS rates at both 6 and 12 months were 0%, 67% and 100%, respectively (p=0.020). Conclusion: This specific score can be used to estimate OS in patients receiving local therapies for single brain metastasis from gynecological malignancies and personalize their care.
International Journal of Gynecological Cancer, 2008
Central nervous system metastasis from gynecological malignancy is a rare phenomenon that has been described in the past 30 years. The objective of this study is to analyze the treatment modalities and prognostic factors for brain metastases from gynecological tumors that predict prolonged survival. A retrospective chart and pathology review of 47 patients diagnosed with a gynecological tumor with brain metastasis in 1994–2004 was performed. Thirty patients had undergone initial diagnosis and treatment at our institution, and 17 patients were referred following primary treatment at an outside institution. Adjusted Chi-square, Kaplan–Meier survival estimates, log-rank tests, and Cox regression analysis were utilized for statistical analysis of the total cohort. Of the 3146 patients with newly diagnosed gynecological cancer in this 10-year period, 30 developed brain metastasis demonstrating an incidence of 0.95%. Overall median survival from the time of diagnosis of brain metastasis w...
Efficacy of gamma knife radiosurgery in brain metastases of primary gynecological tumors
Journal of Neuro-oncology, 2019
Objective Gynecological brain metastases (BM) are rare and usually develop as part of widespread disseminated disease. Despite treatment, the majority of these patients do not survive > 1 year due to advanced extracranial disease. The use of Gamma Knife Radiosurgery (GKRS) for gynecological BM is not well known. The goal of this study is to evaluate the efficacy of GKRS for gynecological BM. Methods We performed a retrospective study of patients with gynecological BM who underwent GKRS between 2002 and 2015. A total of 41 patients were included. Outcome measures were local tumor control (LC), development of new BM and/ or leptomeningeal disease, overall intracranial progression free survival (PFS) and survival. Results LC was 100%, 92%, 80%, 75% and 67% at 3, 6, 9, 12 and 15 months, respectively. PFS was 90%, 61%, 41%, 23% and 13% at 3, 6, 9, 12 and 15 months, respectively. During follow-up (FU), 18 (44%) patients had intracranial progression. Distant BM occurred in 29% of the patients. Local recurrence and distant recurrence occurred after a mean FU time of 15.5 (2.6-71.9) and 11.4 (2-40) months, respectively. Thirty-one (76%) patients died due to extracranial tumor progression and only 2 (5%) patients died due to progressive intracranial disease. The overall mean survival from time of GKRS was 19 months (1-109). The 6-month, 1-year, and 2-year survival rate from the time of GKRS were 71%, 46%, and 22%, respectively. Conclusion GKRS is a good treatment option for controlling gynecological BM. As most patients die due to extracranial tumor progression, their survival might improve with better systemic treatment options in addition to GKRS.
Treatment of advanced and recurrent gynecologic cancer
Cancer
In 1986 73,400 new cases of invasive gynecologic cancer and 45,000 new cases of in situ carcinoma of the uterine cervix (about 9% of all cancers in women) were diagnosed in the US. A significant proportion of these patients die of local failure. In dealing with the wide variety of gynecologic cancers, extreme care must be used in choosing the appropriate treatment program for each problem. Therefore, the full extent of the disease at the time of initial presentation and recurrence must be determined. It is only with these data that appropriate treatment programs can be designed with the maximum potential for long-term control or cure and with the minimum in treatment complication. There are no groups of disease processes like those seen in advanced or recurrent gynecologic cancer that offer such a challenge to the clinical practitioner.
Long-term survival in a patient with brain metastases preceding the diagnosis of endometrial cancer
Journal of Neurosurgery, 2001
✓ Only five patients found to have brain metastasis preceding the diagnosis of endometrial cancer have been reported in the literature, and none of these survived beyond 38 months. The authors report on two patients with primary endometrial cancer who initially presented with cerebral metastasis. One of these patients died of disease 15 months after diagnosis. The other patient is still alive, with no evidence of disease, 171 months after she underwent radiosurgery for a solitary brain metastasis, aggressive cytoreductive abdominal and pelvic surgery, and doxorubicin-based chemotherapy. To the best of their knowledge, the authors believe that no similar observation has been made for any primary gynecological neoplasm, including endometrial, ovarian, or cervical cancer. This is the first report documenting that survival beyond one decade may be achieved after intensive multimodal therapy in selected patients in whom a solitary brain metastasis has been found before diagnosis of endom...