BRAIN METASTASES IN OVARIAN CANCER: OVERVIEW AND OPTIMAL TREATMENT

• Published in: Anticancer research 2008-10, Vol.28 (5C)
• Main Authors: Pietzner, K, El Khalfaoui, K, Oskay-Oezcelik, G, Boehmer, D, Lichtenegger, W, Sehouli, J
• Format: Article
• Language: English
• ISSN: 0250-7005

Ovarian cancer is one of the leading causes of mortality in the field of gynecologic oncology. Central nervous system (CNS) involvement however is rare in presentation and seems to be associated with a very poor prognosis. Clinical as well as autopsy studies in the last decades have confirmed the rarity of occurrence of brain metastases in ovarian cancer, but several authors have recently observed a sharp rise in incidence. While most authors attribute this increase of CNS involvement to prolonged survival achieved through advances in chemotherapy and surgical management, others see it resulting from improved imaging or chemotherapeutic impairment of the blood-brain barrier. Brain metastases from ovarian cancer can present with a panel of often unspecific symptoms which usually results in a late diagnosis of CNS relapse, since cerebral imaging is not part of the routine follow-up. Even serum-CA-125 levels, a valuable tool in predicting recurrence of distant disease, was shown to be incapable of reliable detection in regard to metastatic brain manifestation, leaving the clinician with the need for close patient observation for neurological symptoms in order to diagnose brain metastasis at an early stage. While some reports only indicate the presence of extracranial disease at CNS relapse and time from diagnosis of ovarian cancer to development of brain metastases as prognostic factors for survival, other studies demonstrate the negative impact of multiple cerebral lesions on survival, when compared to single brain metastases. Though great efforts have been made to develop multimodal therapeutic strategies to challenge the rising incidence of brain metastasis in ovarian cancer, CNS involvement is still related with a very poor prognosis. It was shown that a multi-modal approach, combining surgical resection with radiation therapy and even chemotherapy promises the best prolongation of survival and did result in long-term remissions in a few cases. But this aggressive strategy is not applicable to all patients, often due to overall status or inaccessibility of brain metastases to the neurosurgical approach. In these cases stereotactic radiation therapy or gamma-knife-surgery is recommended by many authors to remove single metastatic brain lesions. These techniques should be further discussed as an alternative for whole-brain radiation therapy, as several studies expand its use to other indications such as multiple lesions and with promising results. Based on