Radiation therapy for epithelial ovarian cancer brain metastases: Clinical outcomes and predictors of survival Journal Article

   

Authors:	Teckie, S.; Makker, V.; Tabar, V.; Alektiar, K.; Aghajanian, C.; Hensley, M.; Beal, K.
Article Title:	Radiation therapy for epithelial ovarian cancer brain metastases: Clinical outcomes and predictors of survival
Abstract:	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. © 2013 Teckie et al.; licensee BioMed Central Ltd.
Keywords:	adult; cancer survival; treatment outcome; aged; cancer surgery; major clinical study; overall survival; cisplatin; cancer combination chemotherapy; gemcitabine; paclitaxel; cancer radiotherapy; cancer staging; follow up; ovarian cancer; carboplatin; karnofsky performance status; ovary carcinoma; brain metastasis; craniotomy; meningeal metastasis; brain metastases; palliation; leptomeningeal disease; survival prediction
Journal Title:	Radiation Oncology
Volume:	8
ISSN:	1748-717X
Publisher:	Biomed Central Ltd
Date Published:	2013-02-15
Start Page:	36
Language:	English
DOI:	10.1186/1748-717x-8-36
PROVIDER:	scopus
PMCID:	PMC3608316
PUBMED:	23414446
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-84873742356&partnerID=40&md5=de2f08ca8d3c246d24f3cbf48d3962f2
Notes:	--- - "Export Date: 19 July 2013" - "Source: Scopus"

https://synapse.mskcc.org/synapse/works/has_related_data_chk/44126