Half of all women with advanced ovarian cancer who develop brain cancer have a single metastasis to the brain. Compared with those who have multiple metastatic sites, women who have a single metastasis in the brain have improved survival, according to a retrospective study reported at the 2011 annual meeting of the American Society for Radiation Oncology.
Ovarian cancer patients with multiple metastases to the brain are also more likely to have leptomeningeal disease, in which cancer cells spread throughout the spinal fluid.
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Multivariate analysis identified 4 factors significantly associated with worse survival: Karnofsky performance status >70; uncontrolled primary tumor; 4 or more brain metastases; and leptomeningeal disease.
“This is the largest series to investigate outcomes and predictors of survival in ovarian cancer and brain metastasis. If only one metastasis is present, some patients can achieve a durable response and improved survival if treated with stereotactic radiosurgery or surgery plus radiation therapy,” explained lead author Sewit Teckie, MD, of Memorial Sloan-Kettering Cancer Center in New York City.
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Among 78 women with ovarian cancer who presented with one or more brain metastasis, 50% had only a single metastasis. Another 19% had 2 or 3 metastases at initial diagnosis, 23% had 4 or more, and 8% had developed leptomeningeal disease.
All patients were treated at Memorial Sloan-Kettering Cancer Center between 1983 and 2010. Median age at ovarian cancer diagnosis was 54.8 years, median age at brain metastasis diagnosis was 58.3 years, and 88% had stage III/IV disease at initial diagnosis. Fifty-six percent of patients had metastases in the cerebral hemisphere alone, 15% in the cerebellum alone, and 28% had metastases at both sites.
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If only one metastasis is present, some patients can achieve a durable response and improved survival if treated with stereotactic radiosurgery or surgery plus radiation therapy. ”
—Sewit Teckie, MD
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Following diagnosis of ovarian cancer, median time to detection of brain metastasis was 71.1 months in patients with early-stage disease and 38.3 months in those diagnosed with stage III/IV ovarian cancer. Median follow-up of all patients was 8 months; median follow-up was 15 months for 8 patients thought to be alive at the time of the analysis.
Median survival after developing brain metastasis was 8.9 months, but was 14 months for patients with only one metastasis.
Treatment for metastatic disease included whole-or partial-brain radiation therapy or stereotactic radiosurgery in 92% of patients, while 49% also had surgery. Surgery was typically performed for patients with a single brain metastasis.
Follow-up imaging was available for 39 patients; 33 developed progressive or recurrent metastatic disease, and 10 patients developed leptomeningeal disease. A total of 20.5% of patients had leptomeningeal disease. In 6 patients with leptomeningeal disease treated with radiation, median survival was 4 months; 1 outlier was alive after 1 year.
More cases of leptomeningeal disease were reported in this series compared with other studies of patients with ovarian cancer and brain metastasis, Teckie said. She noted that although leptomeningeal disease is a poor predictor, “this has not previously been analyzed statistically in ovarian cancer.”
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