Claudia Marchetti1, Gabriella Ferrandina2, Gennaro Cormio3, Angela Gambino4, Sabrina Cecere5, Domenica Lorusso6, Ugo De Giorgi7, Stefano Bogliolo8, Anna Fagotti9, Serafina Mammoliti10, Filomena Narducci11, Alice Bergamini12, Paolo Scollo13, Nicoletta Biglia14, Enrico Breda15, Stefano Tamberi16, Marco Marinaccio17, Roberto Angioli18, Laura Salerno19, Maria Chiara Eusebi4, Vera Loizzi3, Giovanni Scambia20, Pierluigi Benedetti Panici19. 1. Department of Gynecological and Obstetrical Sciences and Urological Sciences, University of Rome "Sapienza" Rome, Italy. Electronic address: clamarchetti@libero.it. 2. Department of Medicine and Health Science, University of Molise/Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy. 3. Gynecologic Oncology Unit, University of Bari and Oncology Institute "Giovanni Paolo II", Bari, Italy. 4. Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy. 5. Department of Gynecologic and Urologic Oncology, Fondazione Pascale, National Cancer Institute of Naples, Italy. 6. Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy. 7. Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy. 8. Department of Obstetrics and Gynecology, University Research Hospital "Fondazione IRCCS Policlinico San Matteo" of Pavia, Italy. 9. Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy; Gynecologic Oncology, S. Maria Hospital, University of Perugia, Terni, Italy. 10. Medical Oncology 1, IRCCS Hospital San Martino, Genova, Italy. 11. Medical Oncology Unit, Hospital 'SS. Trinità', Sora, Italy. 12. Department of Obstetrics and Gynecology, San Raffaele Hospital, Milan, Italy. 13. Department of Obstetrics and Gynecology, Hospital Cannizzaro, Catania, Italy. 14. Department of Obstetrics and Gynecology, University of Torino School of Medicine, Torino, Italy. 15. Hospital S. Giovanni Calibita Fatebenefratelli Isola Tiberina, Roma, Italy. 16. Oncology Unit, Faenza Hospital (RA) AUSL Romagna, Italy. 17. Department of Obstetrics and Gynecology, University of Bari, Bari, Italy. 18. Department of Obstetrics and Gynaecology Campus Bio Medico University of Rome, 00128 Rome, Italy. 19. Department of Gynecological and Obstetrical Sciences and Urological Sciences, University of Rome "Sapienza" Rome, Italy. 20. Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy.
Abstract
BACKGROUND: Brain metastases (BM) from epithelial ovarian cancer (EOC) are considered a rare and unfavourable event. There is no consensus regarding the best management of these patients. METHODS: A multicenter retrospective analysis of patients with BM from EOC treated between 1997 and 2014 in 18 institutions of the MITO (Multicenter Italian Trials in Ovarian cancer) group was conducted. Univariate and multivariate analysis were performed. RESULTS: A total of 174 women were identified as having BM from EOC. The median time interval between primary diagnosis of EOC and occurrence of BM was 26months (range 2-129months). The median overall survival from primary EOC diagnosis was 48months (95% CI 39.5-56.4months) and from diagnosis of BM was 12months (95% CI 9.6-14.3months). The majority of enrolled women (81.7%) were classified as sensitive to platinum-based chemotherapy. Four variables were significantly associated with poor overall survival in multivariate analysis: multiple BM [HR: 1.86 (95% CI: 1.22-2.84)], presence of extracranial disease [HR: 1.77 (95% CI: 1.11-2.83)] age [HR: 1.74 (95% CI: 1.17-2.59)], and monotherapy [HR: 2.57 (95% CI: 1.64-3.86)]. On the contrary, residual tumor at primary surgery, FIGO stage at primary diagnosis and platinum sensitivity were found to have no significant impact on survival from diagnosis of brain lesions. CONCLUSIONS: Our results suggest that BM is a rare and late manifestation of EOC, with a 12-month life-span expectation. Multiple approach is a positive independent prognostic factor and should be proposed to carefully selected patients.
BACKGROUND: Brain metastases (BM) from epithelial ovarian cancer (EOC) are considered a rare and unfavourable event. There is no consensus regarding the best management of these patients. METHODS: A multicenter retrospective analysis of patients with BM from EOC treated between 1997 and 2014 in 18 institutions of the MITO (Multicenter Italian Trials in Ovarian cancer) group was conducted. Univariate and multivariate analysis were performed. RESULTS: A total of 174 women were identified as having BM from EOC. The median time interval between primary diagnosis of EOC and occurrence of BM was 26months (range 2-129months). The median overall survival from primary EOC diagnosis was 48months (95% CI 39.5-56.4months) and from diagnosis of BM was 12months (95% CI 9.6-14.3months). The majority of enrolled women (81.7%) were classified as sensitive to platinum-based chemotherapy. Four variables were significantly associated with poor overall survival in multivariate analysis: multiple BM [HR: 1.86 (95% CI: 1.22-2.84)], presence of extracranial disease [HR: 1.77 (95% CI: 1.11-2.83)] age [HR: 1.74 (95% CI: 1.17-2.59)], and monotherapy [HR: 2.57 (95% CI: 1.64-3.86)]. On the contrary, residual tumor at primary surgery, FIGO stage at primary diagnosis and platinum sensitivity were found to have no significant impact on survival from diagnosis of brain lesions. CONCLUSIONS: Our results suggest that BM is a rare and late manifestation of EOC, with a 12-month life-span expectation. Multiple approach is a positive independent prognostic factor and should be proposed to carefully selected patients.
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