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Cabitza E, Pirola M, Baldessari C, Bernardelli G, Zunarelli E, Pipitone S, Vitale MG, Nasso C, Molinaro E, Oltrecolli M, D'Agostino E, Mandato VD, Palicelli A, Dominici M, Sabbatini R. Cerebellar metastasis of ovarian cancer: a case report. J Med Case Rep 2023; 17:553. [PMID: 38115068 PMCID: PMC10731881 DOI: 10.1186/s13256-023-04211-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 10/12/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Ovarian cancer is metastatic at presentation in about 62% of cases, but brain metastases are rare, reported in 3.3-4% of patients. Brain metastasis seems to be more frequent in advanced stages at diagnosis and in patients with BRCA1/2 mutation. CASE PRESENTATION We present a case of a 47-year-old Caucasian woman, BRCA wild type, with an ovarian cancer that started with single cerebellar metastasis. CONCLUSION Brain metastases in ovarian cancer are rare and complex for diagnosis and management. This case focuses both on diagnosis and treatment, emphasizing the importance of a multimodal approach in a multidisciplinary team.
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Affiliation(s)
- Eleonora Cabitza
- Oncology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Marta Pirola
- Oncology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy.
| | - Cinzia Baldessari
- Oncology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | | | - Elena Zunarelli
- Anatomic Pathology Unit, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Stefania Pipitone
- Oncology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | | | | | | | - Marco Oltrecolli
- Oncology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Elisa D'Agostino
- Oncology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | | | - Andrea Palicelli
- Pathology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Dominici
- Oncology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Roberto Sabbatini
- Oncology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
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2
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Liu S, Yan Y, Cui Z, Feng H, Zhong F, Liu Z, Li Y, Ou X, Li W. Relationship between PIWIL1 gene polymorphisms and epithelial ovarian cancer susceptibility among southern Chinese woman: a three-center case-control study. BMC Cancer 2023; 23:1149. [PMID: 38012622 PMCID: PMC10680212 DOI: 10.1186/s12885-023-11651-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/17/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE To investigate the potential correlation between piwi-like RNA-mediated gene silencing 1 (PIWIL1) polymorphisms and susceptibility to epithelial ovarian cancer (EOC). METHODS A case-control study was conducted to evaluate the susceptibility of EOC using multinomial logistic regression analysis. The study analyzed the relationship between five functional single nucleotide polymorphisms (SNPs) in the PIWIL1 gene and EOC risk. Genotyping of 288 cases and 361 healthy samples from South China was identified using a TaqMan assay. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to estimate the relationship between the five selected SNPs and EOC susceptibility. RESULTS Among the five SNPs analyzed, the rs10848087 G > A and rs7957349 G > C variants significantly increased the susceptibility of EOC, rs10773771 C > T was associated with a decreased risk of EOC, while the rs35997018 and rs1106042 variants were not in Hardy-Weinberg equilibrium (p < 0.05). The rs10848087 G > A was significantly associated with increased risk of EOC in individuals with metastasis, FIGO stage I and III, low and high pathological grade, tumor numbers ≤ 3 and > 3, tumor size > 3 cm and ≤ 3 cm, pregnant more than 3 times, pre-menopausal status, and strong positive expression of ER (estrogen receptor), PR (progesterone receptor), PAX8 (paired-box 8), wild-type p53 (tumor protein 53), WT1 (Wilm's tumor gene), P16 (cyclin-dependent kinase inhibitor 2A). In addition, rs10848087 G > A enhanced the EOC risk of cases with negative/mild positive expression of wild p53 and Ki67, and with or without mutant p53 expression. The rs7957349 G > C variant was linked to an increased risk of EOC in subgroups with certain characteristics, including age equal or less than 53 years, metastasis, clinical stage I, low pathological grade, tumor number, tumor size, pregnant times, post-menopause, pre-menopause, and strong positive expression of wild p53 and Ki67 (Antigen identified by monoclonal antibody Ki-67), as well as without mutant p53 expression. The rs10773771 CT/TT alleles were identified to have a protective effect on EOC in women aged 53 years or older, as well as in cases with metastasis, advanced clinical stage, high pathological grade, multiple tumors, tumor size equal to or less than 3 cm, history of pregnancy, post-menopausal status, and strong positive expression of ER, PR, wild-type p53, PAX8, WT1, P16, and Ki67. Furthermore, rs10773771 CT/TT also showed a protective effect in patients with negative or mildly positive expression of PR, PAX8, wild-type p53, WT1, and P16, as well as positive expression of mutant p53. Compared to the reference haplotype GCG, individuals harboring haplotypes GTG were found to have a significantly decreased susceptibility to EOC. PIWIL1 was significantly expressed in the thyroid, pituitary, and adrenal glands with rs7957349 CC alleles. CONCLUSIONS PIWIL1 rs10848087 and rs7957349 were associated with increased risk of EOC, while rs10773771 may have a protective effect against EOC. These genetic variants may serve as potential biomarkers for EOC susceptibility in the South China population.
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Affiliation(s)
- Shanshan Liu
- Department of Hematology and Oncology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China
| | - Yaping Yan
- Department of Hematology and Oncology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China
| | - Zhizhong Cui
- Department of Traditional Chinese Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong Province, China
| | - Haipeng Feng
- Department of Pathology, Shunde Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Fengmei Zhong
- Department of Pathology, Shunde Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Ziguang Liu
- Department of Pathology, Shunde Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Yan Li
- Medical Research Center, Shunde Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Xiang Ou
- The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China.
| | - Wenjuan Li
- Medical Research Center, Shunde Hospital, Southern Medical University, Foshan, 528000, Guangdong, China.
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3
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Tahir N, Ram A, Jain N, Vemireddy LP, Zahra F. Leptomeningeal Carcinomatosis in Epithelial Ovarian Cancer: A Diagnostic Challenge. Cureus 2021; 13:e14440. [PMID: 33996304 PMCID: PMC8115684 DOI: 10.7759/cureus.14440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Leptomeningeal carcinomatosis (LCM), also known as neoplastic meningitis, is a rare entity. It is generally seen in solid tumors. Ovarian cancers can infrequently cause LCM. The clinical presentation is variable. Diagnosis is made by a lumbar puncture that shows malignant cells in the cerebrospinal fluid (CSF) and usually correlates with imaging findings. Given the low individual sensitivities of lumbar puncture (55%) and magnetic resonance imaging (70%), it is recommended to combine both modalities for optimal diagnostic results. Treatment options vary depending on the type of primary carcinoma, however, the prognosis is guarded. We report a case of LCM in a patient with stage IV epithelial ovarian cancer in remission, which became a diagnostic challenge due to a lack of imaging findings.
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Affiliation(s)
- Nayha Tahir
- Internal Medicine, Chicago Medical School, Rosalind Franklin University of Medicine and Science, McHenry, USA
| | - Aatma Ram
- Internal Medicine, Chicago Medical School, Rosalind Franklin University of Medicine and Science, McHenry, USA
| | - Nikita Jain
- Internal Medicine, Chicago Medical School, Rosalind Franklin University of Medicine and Science, McHenry, USA
| | | | - Farah Zahra
- Internal Medicine, Chicago Medical School, Rosalind Franklin University of Medicine and Science, McHenry, USA
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4
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Ferlini L, Peluso L, Lolli V, Gaspard N, Lefranc F. Prognosis of patients treated in a single neurosurgical reference centre for brain metastasis caused by dormant disseminated cells. Oncol Lett 2021; 21:454. [PMID: 33907564 PMCID: PMC8063273 DOI: 10.3892/ol.2021.12715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/30/2020] [Indexed: 11/06/2022] Open
Abstract
Brain metastasis (BM) is a frequent complication of systemic cancer usually associated with poor prognosis. Survival depends on numerous factors, which complicates prognosis and treatment. It has been suggested that BM growing from previously dormant disseminated tumour cells (DTCs) may exhibit a milder phenotype than BM derived from continuously progressing metastatic cells; however, to the best of our knowledge, the prognosis of patients presenting with BM from dormant DTCs is unknown. The present study retrospectively compared survival data, collected from a single neurosurgical centre, between patients presenting with BM from previously dormant DTCs and patients with non-dormant BM. A total of 262 medical records were reviewed. In the univariate Cox regression analysis, the median survival of the dormant BM group was statistically longer than that of the non-dormant group (P=0.048); a trend towards a longer survival persisted after correcting for age, presence of breast cancer and treatment options (P=0.057), which are all factors known to influence outcome. The improved outcome of these patients could be considered in models for prognostication. Moreover, the development of therapies able to eradicate dormant DTCs could provide a new promising strategy to prolong the survival of patients with a favourable prognosis.
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Affiliation(s)
- Lorenzo Ferlini
- Department of Neurology, Erasmus Hospital, Free University of Bruxelles, B-1070 Brussels, Belgium
| | - Lorenzo Peluso
- Department of Intensive Care, Erasmus Hospital, Free University of Bruxelles, B-1070 Brussels, Belgium
| | - Valentina Lolli
- Department of Radiology, Erasmus Hospital, Free University of Bruxelles, B-1070 Brussels, Belgium
| | - Nicolas Gaspard
- Department of Neurology, Erasmus Hospital, Free University of Bruxelles, B-1070 Brussels, Belgium
| | - Florence Lefranc
- Department of Neurosurgery, Erasmus Hospital, Free University of Bruxelles, B-1070 Brussels, Belgium
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5
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Rout S, Rai S, Dabkara D, Ghosh J, Chakraborty B, Roy A, Ghosh A, Bhaumik J. Managing Brain Lesions in Gynecological Cancers: A Case Series. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2020. [DOI: 10.1007/s40944-020-00409-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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6
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Brain Metastases from Ovarian Cancer: Current Evidence in Diagnosis, Treatment, and Prognosis. Cancers (Basel) 2020; 12:cancers12082156. [PMID: 32759682 PMCID: PMC7464214 DOI: 10.3390/cancers12082156] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 12/12/2022] Open
Abstract
With this review, we provide the state of the art concerning brain metastases (BMs) from ovarian cancer (OC), a rare condition. Clinical, pathological, and molecular features, treatment options, and future perspectives are comprehensively discussed. Overall, a diagnosis of high-grade serous OC and an advanced disease stage are common features among patients who develop brain metastases. BRCA1 and BRCA2 gene mutations, as well as the expression of androgen receptors in the primary tumor, are emerging risk and prognostic factors which could allow one to identify categories of patients at greater risk of BMs, who could benefit from a tailored follow-up. Based on present data, a multidisciplinary approach combining surgery, radiotherapy, and chemotherapy seem to be the best approach for patients with good performance status, although the median overall survival (<1 year) remains largely disappointing. Hopefully, novel therapeutic avenues are being explored, like PARP inhibitors and immunotherapy, based on our improved knowledge regarding tumor biology, but further investigation is warranted.
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7
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Xi S, Li Z, Guo Q, Lin W, Liang X, Ma L. Prognostic Factors among Brain Metastases in Newly Diagnosed Ovary Cancer: A Large Real-world Study. J Cancer 2020; 11:4625-4640. [PMID: 32489480 PMCID: PMC7255353 DOI: 10.7150/jca.44494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/27/2020] [Indexed: 01/06/2023] Open
Abstract
Background: Population-based data on the prognosis of brain metastases at initial diagnosis of ovary cancer (OCBM) are currently lacking. Besides, the effective treatment for OCBM patients is still controversial now. The study aimed to explore the prognostic factors among OCBM. Methods: We retrospectively reviewed the OCBM patients from the Surveillance, Epidemiology, and End Result (SEER) database of the National Cancer Institute to investigate predictors of the presence of OCBM and its' prognostic factors related to all-cause mortality. We employed multivariable logistic and Cox regression analysis. Furthermore, to minimize the impact of potential confounding factors, we conducted a 1:1 propensity score matching (PSM) analysis. Results: A total of 29,512 cases of OC patients entered into the study, including 89 patients with brain metastases of ovarian cancer, which accounted for 0.30% of the entire cohort and 12.02% of the metastatic disease subset. We identified eight factors, including laterality, histology, surgery, radiotherapy, chemotherapy, and extracranial metastatic sites to bone, liver, and lung, as predictors of OCBM based on multivariable logistic regression among the entire cohort. The median survival time of OCBM was 2.0 months, and the interquartile range was 2.0-10.0 mo. The patients who received comprehensive treatment had better prognosis. Based on the multivariable Cox model, marital status, surgery, chemotherapy, and extensive therapy (including RSC, SC, and RC) were identified as predictors of OS. Besides, a new factor (brain metastasis) was identified by 1:1 PSM -based multiple Cox regression, apart from the above prognostic factors for OS. Conclusions: This study provided a population-based estimate of the proportion and prognosis for newly diagnosed ovary cancer with brain metastases. These findings may add materials to guidelines for preliminary screening and optimal treatment of OCBM patients.
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Affiliation(s)
- Sujuan Xi
- The Reproductive Medical Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518107, China
| | - Zaiyi Li
- The Reproductive Medical Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518107, China
| | - Quan Guo
- Department of gynaechology, Shengjing Hospital Medical University, Shenyang, China
| | - Wenjing Lin
- The Reproductive Medical Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518107, China
| | - Xiaokun Liang
- Shenzhen Colleges of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, Guangdong, 518055 China
| | - Lin Ma
- The Reproductive Medical Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518107, China
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8
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Nagtegaal SHJ, Hulsbergen AFC, van Dorst EBL, Kavouridis VK, Jessurun CAC, Broekman MLD, Smith TR, Verhoeff JJC. Age, pathology and CA-125 are prognostic factors for survival in patients with brain metastases from gynaecological tumours. Clin Transl Radiat Oncol 2020; 24:11-15. [PMID: 32596517 PMCID: PMC7306503 DOI: 10.1016/j.ctro.2020.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/01/2020] [Accepted: 05/01/2020] [Indexed: 11/24/2022] Open
Abstract
The largest cohort of brain metastases patients from gynaecological tumours. CA-125, age and primary tumour type are prognostic for survival. This will inform clinical practice and aid the development of new prognostic tools.
Background and purpose Brain metastases originating from gynaecological tumours are a rare phenomenon, but have an increasing incidence due to better targeted therapies. This study aimed to identify factors that predict survival in these patients, which can be used in creating a robust prognostic tool for shared decision making. Materials and methods We identified a consecutive cohort of 73 patients treated for gynaecological brain metastases in two tertiary institutions. Baseline demographics, pathology and serum CA-125 were included in a multivariable Cox proportional hazards model. Results Median overall survival in our cohort was 14.4 months, with a one-year survival of 56.4% and a two-year survival of 39.1%. Thirty-eight patients (52.1%) had ovarian carcinoma as the primary malignancy. The following factors were significantly associated with survival: age (HR 1.05 per year), CA-125 (HR 1.02 par 50 U/ml), and uterine and vulvar primary tumours (when compared to ovarian carcinoma, with HRs 3.07 and 8.70). A post-hoc analysis with primary tumour site reclassified into ovary versus non-ovary showed a HR of 0.50 for ovarian primary tumour type. Conclusion We have found that age, pathology and CA-125 are prognostic factors for survival in patients with brain metastases from gynaecological tumours. Our findings may provide a foundation for future development of prediction models, for the benefit of both patients and physicians.
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Affiliation(s)
- S H J Nagtegaal
- Department of Radiation Oncology, University Medical Center Utrecht, HP Q 00.3.11, 3508 GA, Utrecht, the Netherlands
| | - A F C Hulsbergen
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, United States.,Departments of Neurosurgery, Haaglanden Medical Center and Leiden University Medical Center, Leiden University, J11-R-83, Postbus 9600, 2300 RC Leiden, the Netherlands
| | - E B L van Dorst
- Department of Gynaecologic Oncology, University Medical Center Utrecht, HP F.05.1.26, 3508 GA, Utrecht, the Netherlands
| | - V K Kavouridis
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, United States
| | - C A C Jessurun
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, United States
| | - M L D Broekman
- Departments of Neurosurgery, Haaglanden Medical Center and Leiden University Medical Center, Leiden University, J11-R-83, Postbus 9600, 2300 RC Leiden, the Netherlands.,Department of Neurology, Massachusetts General Hospital, Mailcode: WACC 8-835, 55 Fruit Street, Boston, MA 02114, United States
| | - T R Smith
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, United States
| | - J J C Verhoeff
- Department of Radiation Oncology, University Medical Center Utrecht, HP Q 00.3.11, 3508 GA, Utrecht, the Netherlands
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9
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Mittica G, Goia M, Gambino A, Scotto G, Fonte M, Senetta R, Aglietta M, Borella F, Sapino A, Katsaros D, Maggiorotto F, Ghisoni E, Giannone G, Tuninetti V, Genta S, Eusebi C, Momi M, Cassoni P, Valabrega G. Validation of Androgen Receptor loss as a risk factor for the development of brain metastases from ovarian cancers. J Ovarian Res 2020; 13:53. [PMID: 32366278 PMCID: PMC7199337 DOI: 10.1186/s13048-020-00655-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/24/2020] [Indexed: 12/21/2022] Open
Abstract
Background Central nervous system (CNS) spreading from epithelial ovarian carcinoma (EOC) is an uncommon but increasing phenomenon. We previously reported in a small series of 11 patients a correlation between Androgen Receptor (AR) loss and localization to CNS. Aims of this study were: to confirm a predictive role of AR loss in an independent validation cohort; to evaluate if AR status impacts on EOC survival. Results We collected an additional 29 cases and 19 controls as validation cohort. In this independent cohort at univariate analysis, cases exhibited lower expression of AR, considered both as continuous (p < 0.001) and as discrete variable (10% cut-off: p < 0.003; Immunoreactive score: p < 0.001). AR negative EOC showed an odds ratio (OR) = 8.33 for CNS dissemination compared with AR positive EOC. Kaplan-Meier curves of the combined dataset, combining data of new validation cohort with the previously published cohort, showed that AR < 10% significantly correlates with worse outcomes (p = 0.005 for Progression Free Survival (PFS) and p = 0.002 for brain PFS (bPFS) respectively). Comparison of AR expression between primary tissue and paired brain metastases in the combined dataset did not show any statistically significant difference. Conclusions We confirmed AR loss as predictive role for CNS involvement from EOC in an independent cohort of cases and controls. Early assessment of AR status could improve clinical management and patients’ prognosis.
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Affiliation(s)
- Gloria Mittica
- Unit of Oncology, ASL Verbano Cusio Ossola (VCO), Domodossola, Italy
| | - Margherita Goia
- Unit of Pathology, Città della Salute e della Scienza, Turin, Italy.,Department of Medical Sciences, University of Turin, Turin, Italy
| | - Angela Gambino
- Department Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Giulia Scotto
- Department of Oncology, University of Torino, Turin, Italy. .,Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy.
| | - Mattia Fonte
- Department of Oncology, University of Torino, Turin, Italy
| | - Rebecca Senetta
- Unit of Pathology, Città della Salute e della Scienza, Turin, Italy.,Department of Medical Sciences, University of Turin, Turin, Italy
| | - Massimo Aglietta
- Department of Oncology, University of Torino, Turin, Italy.,Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy
| | - Fulvio Borella
- Department of Surgical Sciences, Gynecology, AOU, Città della Salute e della Scienza, Turin, Italy
| | - Anna Sapino
- Department of Medical Sciences, University of Turin, Turin, Italy.,Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy
| | - Dionyssios Katsaros
- Department of Surgical Sciences, Gynecology, AOU, Città della Salute e della Scienza, Turin, Italy
| | | | - Eleonora Ghisoni
- Department of Oncology, University of Torino, Turin, Italy.,Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy
| | - Gaia Giannone
- Department of Oncology, University of Torino, Turin, Italy.,Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy
| | - Valentina Tuninetti
- Department of Oncology, University of Torino, Turin, Italy.,Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy
| | - Sofia Genta
- Department of Oncology, University of Torino, Turin, Italy.,Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy
| | - Chiara Eusebi
- Department Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Marina Momi
- Department Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Paola Cassoni
- Unit of Pathology, Città della Salute e della Scienza, Turin, Italy.,Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giorgio Valabrega
- Department of Oncology, University of Torino, Turin, Italy.,Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy
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10
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Ordoñez RMLS, Amendola BE, Martinez PF, Wolf A, Coy SR, Amendola M. Radiosurgery for brain metastases from ovarian cancer: an analysis of 25 years' experience with Gamma Knife treatment. Rep Pract Oncol Radiother 2019; 24:667-671. [PMID: 31719805 DOI: 10.1016/j.rpor.2019.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 07/18/2019] [Accepted: 10/07/2019] [Indexed: 10/25/2022] Open
Abstract
Purpose We present our results in the treatment of brain metastases (BM) from ovarian cancer using Gamma Knife Radiosurgery (GKRS) over the last 25 years in a single institution. Background Gamma Knife Radiosurgery has become increasingly important in the management of brain metastases from ovarian cancer due to improving results from systemic disease and the need for better outcomes. Material and methods The medical records of 9 patients with brain metastases from ovarian cancer treated with GKRS between 1993 and 2018 were reviewed. Median age at first treatment was 57 years (range 39-76). Forty-two brain metastases were treated with 16 procedures. Median tumor volume was 1.8cc ranging from 0.2 to 30.3cc (there were five patients with a tumor volume exceeding 10cc). Median prescription dose was 16 Gy. Results Using Kaplan Meier estimates, the median OS after diagnosis was 48.1 months and the median OS after GKRS was 10.6 months (ranging from 2.5 to 81 months). The Kaplan Meier survival rates were 31.3%, and 6.5% at 2 and 5 years after GKRS, respectively. Treatment procedure was well tolerated and no patient presented with acute or chronic toxicity. Two of 9 patients had a tumor requiring retreatment (local control of 95% 40/42). Two out of the 7 patients evaluated for cause of death expired due to progression of brain metastases and the remaining ones died of systemic disease with brain control. Conclusions GKRS for BM from ovarian cancer is a safe and effective modality. Our findings are in agreement with the recent literature indicating that women with brain metastases from ovarian cancer will benefit with radiosurgery and may achieve long term survival with brain control.
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Affiliation(s)
| | - Beatriz E Amendola
- Innovative Cancer Institute, 5995 SW 71 Street, South Miami, FL 33143, United States
| | - Paul F Martinez
- Innovative Cancer Institute, 5995 SW 71 Street, South Miami, FL 33143, United States
| | - Aizik Wolf
- Miami Neuroscience Center, 6129 SW 70 Street, South Miami, FL 33143, United States
| | - Sammie R Coy
- Miami Neuroscience Center, 6129 SW 70 Street, South Miami, FL 33143, United States
| | - Marco Amendola
- Innovative Cancer Institute, 5995 SW 71 Street, South Miami, FL 33143, United States
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11
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Kawagoe Y, Nakayama T, Matuzawa S, Fukushima K, Onishi J, Sato Y, Nagai K, Sameshima H. Epithelial Ovarian Carcinoma Associated with Metastases to Central Nervous System: Two Case Reports. Case Rep Obstet Gynecol 2018; 2018:4301247. [PMID: 30386663 PMCID: PMC6189680 DOI: 10.1155/2018/4301247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 09/18/2018] [Indexed: 11/30/2022] Open
Abstract
We experienced two rare cases of metastases to the central nervous system (cerebral and leptomeningeal metastases) from primary epithelial ovarian carcinoma. The first case was a 55-year-old woman who developed carcinomatous meningitis while on chemotherapy for ovarian cancer stage IIIC. Cytological analysis confirmed carcinomatous cells of ovarian origin in the cerebrospinal fluid. Magnetic resonance imaging demonstrated abnormal hyperintensity in the cerebral sulci on fluid attenuated inversion recovery (FLAIR) sequence with enhanced gadolinium indicating leptomeningeal metastases. Her consciousness rapidly declined and she died 42 days after diagnosis. The second case was a 63-year-old woman who underwent surgery for ovarian cancer and who was diagnosed as stage IA. Thirty-eight months after surgery, she developed weakness of the left hand and headaches. A CT scan revealed metastases to the right cerebrum and she was treated with surgical resection followed by radiotherapy. Five months after resection, she developed ileus caused by multiple relapses in the pelvis. Despite chemotherapy, her performance status declined and she died nine months after the resection. Both cases were rare because the first case was isolated leptomeningeal metastases, and the second case was confirmed relapse site in the cerebrum due to neurological symptoms despite her early clinical stage.
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Affiliation(s)
- Yasuyuki Kawagoe
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Tetsuo Nakayama
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Satoshi Matuzawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Kazuko Fukushima
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Junji Onishi
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Yuichiro Sato
- Department of Diagnostic Pathology, University of Miyazaki Hospital, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Kimihiro Nagai
- Department of Palliative Care, Miyazaki Medical Association Hospital, 738-1 Funado, Shinbeppu, Miyazaki City, Miyazaki 889-0834, Japan
| | - Hiroshi Sameshima
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
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12
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Mittica G, Senetta R, Scotto G, Aglietta M, Maggiorotto F, Ghisoni E, Genta S, Boldorini R, Manini C, Morra I, Buosi R, Sapino A, Cassoni P, Valabrega G. Androgen receptor status predicts development of brain metastases in ovarian cancers. Oncotarget 2018; 8:41143-41153. [PMID: 28467804 PMCID: PMC5522232 DOI: 10.18632/oncotarget.17068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 03/17/2017] [Indexed: 12/20/2022] Open
Abstract
Brain metastases are uncommon localizations in epithelial ovarian cancer (EOC), their reported incidence is increasing and no predictive biomarkers have been identified yet. Goals of this study were: i) to define a possible association between Estrogen Receptor (ER), Progesterone Receptor (PR), Androgen Receptor (AR), human EGF receptor 2 (HER2) and brain progression in EOC patients, and ii) to identify differences in ER, PR, AR and HER2 protein expression from primary EOC and its matched resected brain metastasis. A retrospective series of 11 EOC with matched brain metastasis surgically removed was collected. For comparison, a “Control dataset” of 22 patients, without evidence of brain involvement after an adequate follow up was matched. ER, PR, AR and HER2 status were analyzed by means of immunohistochemistry forCases (both primary and metastatic lesions) and Controls. Univariate analysis showed that AR status was significantly associated with brain localization, both considered as discrete variable (cut-off: 10%, p=0.013) and as continuous one (p=0.035). Multivariate analysis confirmed this trend (p=0.053). When considered as continuous variables, ER and AR showed greater expression in primary tumors in comparison with brain metastases (p=0.013 and p=0.032, respectively). In our series, AR predicts brain involvement, with a 9.5 times higher propensity for AR-negative EOC. Moreover, brain dissemination is probably the result of progressive dedifferentiation of primary tumor, shown by reduction of ER and AR expression in metastases. Further studies are required, in order to anticipate and improve multimodal treatment of brain metastases.
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Affiliation(s)
- Gloria Mittica
- Department of Oncology, University of Turin, Turin, Italy.,Division of Medical Oncology-1, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Italy
| | - Rebecca Senetta
- Unit of Pathology Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Italy
| | - Giulia Scotto
- Department of Oncology, University of Turin, Turin, Italy
| | - Massimo Aglietta
- Department of Oncology, University of Turin, Turin, Italy.,Division of Medical Oncology-1, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Italy
| | - Furio Maggiorotto
- Division of Gynecologic Oncology, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Italy
| | - Eleonora Ghisoni
- Department of Oncology, University of Turin, Turin, Italy.,Division of Medical Oncology-1, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Italy
| | - Sofia Genta
- Department of Oncology, University of Turin, Turin, Italy.,Division of Medical Oncology-1, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Italy
| | - Renzo Boldorini
- Department of Health Science, University of Eastern Piedmont "Amedeo Avogadro", Novara, Italy
| | - Claudia Manini
- Unit of Pathology, Giovanni Bosco Hospital, Turin, Italy
| | - Isabella Morra
- Unit of Pathology, Città della Salute e della Scienza, Turin, Italy
| | - Roberta Buosi
- Division of Oncology, Santo Spirito Hospital, Casale Monferrato, Italy
| | - Anna Sapino
- Unit of Pathology Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Italy.,Department of Medical Sciences, University of Turin, Turin, Italy
| | - Paola Cassoni
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giorgio Valabrega
- Department of Oncology, University of Turin, Turin, Italy.,Division of Medical Oncology-1, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Italy
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13
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Martin M, Grisham RN, Turashvili G, Halpenny DF, Aghajanian CA, Makker V. Brain metastasis in advanced serous borderline tumor of the ovary: A case presentation. Gynecol Oncol Rep 2017; 22:9-12. [PMID: 28932807 PMCID: PMC5596333 DOI: 10.1016/j.gore.2017.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 08/31/2017] [Accepted: 09/02/2017] [Indexed: 11/28/2022] Open
Abstract
•Brain metastasis is an extremely rare secondary site of ovarian cancer metastasis.•Serous borderline tumor with brain metastasis has not been previously reported.•This is a rare case of brain metastasis in a patient with advanced serous borderline tumor.
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Affiliation(s)
- Madhuri Martin
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rachel N Grisham
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Gulisa Turashvili
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Darragh F Halpenny
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carol A Aghajanian
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Vicky Makker
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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14
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Krupa M, Byun K. Leptomeningeal carcinomatosis and bilateral internal auditory canal metastases from ovarian carcinoma. Radiol Case Rep 2017; 12:386-390. [PMID: 28491194 PMCID: PMC5417755 DOI: 10.1016/j.radcr.2017.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 01/31/2017] [Accepted: 03/06/2017] [Indexed: 12/11/2022] Open
Abstract
Ovarian cancer, a leading cause of death in women, typically spreads locally and rarely metastasizes to the brain or seeds the leptomeninges. We present a case of a 62-year-old woman with a history of treated ovarian cell carcinoma who developed bilateral sensorineural deafness and right-sided facial weakness and on imaging was found to have bilateral internal auditory canal (IAC) masses and leptomeningeal carcinomatosis, pathologically proven by cerebrospinal fluid cytology. We discuss her magnetic resonance imaging and positron emission tomography-computed tomography findings and review the imaging characteristics of IAC metastases. Finally, we review the literature on leptomeningeal carcinomatosis from ovarian cancer and discuss the high incidence of bilateral IAC metastases in patients with leptomeningeal carcinomatosis.
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Affiliation(s)
- Martin Krupa
- Department of Radiology, Eastern Virginia Medical School, 600 Gresham Drive, Norfolk, VA 23507, USA
| | - Kathy Byun
- Department of Radiology, Eastern Virginia Medical School, 600 Gresham Drive, Norfolk, VA 23507, USA
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15
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Bangham M, Goldstein R, Walton H, Ledermann JA. Olaparib treatment for BRCA-mutant ovarian cancer with leptomeningeal disease. Gynecol Oncol Rep 2016; 18:22-24. [PMID: 27819019 PMCID: PMC5081421 DOI: 10.1016/j.gore.2016.10.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/06/2016] [Accepted: 10/17/2016] [Indexed: 11/30/2022] Open
Abstract
Leptomeningeal disease occurs more commonly in BRCA-mutated ovarian cancer. A clinically significant dose of olaprib is able to penetrate the leptomeninges. Leptomeningeal metastases in a BRCA-mutated ovarian cancer responded to olaparib.
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Affiliation(s)
| | | | - Henry Walton
- UCL Hospitals, 235 Euston Rd, Fitzrovia, London NW1 2BU, UK
| | - Jonathan A Ledermann
- UCL Hospitals, 235 Euston Rd, Fitzrovia, London NW1 2BU, UK; UCL Cancer Institute, 90 Tottenham Court Road, London W1T 4TJ, UK
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16
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Gilani MA, Williams NL, Giordano C, Rosenblum N, Shi W, Anne P, Schilder RJ. Brain Metastases in Patients with Gynecologic Cancers: A Single Institution Experience and Review of the Literature. ACTA ACUST UNITED AC 2016; 6:544-552. [PMID: 31552146 PMCID: PMC6758932 DOI: 10.4236/ojog.2016.69070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objective: Brain Metastasis (BM) from primary gynecologic cancers is a rare entity. The advances and successes in the treatment of primary gynecologic malignancies, have led to prolonged survival and, a higher incidence of BM. This study aims to report the experience at our institution in managing these patients, and provide possible data points that may be essential to note as prognostic factors, and see if our findings are consistent with the literature in this subject. We also aim to provide a brief literature review of patients with gynecologic cancers and BM. Methods: This is a small single institution retrospective study of 23 patients with a gynecologic malignancy and BM, identified between the years 2007–2015. Data were collected on variables including patient demographics, disease and treatment. Results: The median overall survival from the primary diagnosis was 28 months. Median time from diagnosis of BM to death was 9 months. Conclusion: The outcomes in our study are similar to what is stated in the current literature with regard to BM from gynecologic malignancies. Our literature search also revealed that the molecular analysis and treatment of the primary tumor remain important to prevent BMs. The tendency of tumors to metastasize varies for one tumor type to another for the same type of tumor. The tendency to develop BM may not only depend on risk factors such as stage, grade, and histology, but also on the genetic profile of the primary tumor. The study suggests that multimodal treatment of BM has better outcomes in managing BM from gynecologic cancers.
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Affiliation(s)
| | - Noelle L Williams
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Carolyn Giordano
- Office of Institutional Research, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Wenyin Shi
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Pramila Anne
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Russell J Schilder
- Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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17
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Shin HK, Kim JH, Lee DH, Cho YH, Kwon DH, Roh SW. Clinical Outcomes of Gamma Knife Radiosurgery for Metastatic Brain Tumors from Gynecologic Cancer : Prognostic Factors in Local Treatment Failure and Survival. J Korean Neurosurg Soc 2016; 59:392-9. [PMID: 27446522 PMCID: PMC4954889 DOI: 10.3340/jkns.2016.59.4.392] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/21/2016] [Accepted: 04/07/2016] [Indexed: 01/20/2023] Open
Abstract
Objective Brain metastases in gynecologic cancer (ovarian, endometrial, and cervical cancer) patients are rare, and the efficacy of Gamma Knife Radiosurgery (GKRS) to treat these had not been evaluated. We assessed the efficacy of GKRS and prognostic factors for tumor control and survival in brain metastasis from gynecologic cancers. Methods This retrospective study was approved by the institutional review board. From May 1995 to October 2012, 26 women (mean age 51.3 years, range 27–70 years) with metastatic brain tumors from gynecologic cancer were treated with GKRS. We reviewed their outcomes, radiological responses, and clinical status. Results In total 24 patients (59 lesions) were available for follow-up imaging. The median follow-up time was 9 months. The mean treated tumor volume at the time of GKRS was 8185 mm3 (range 10–19500 mm3), and the median dose delivered to the tumor margin was 25 Gy (range, 10–30 Gy). A local tumor control rate was 89.8% (53 of 59 tumors). The median overall survival was 9.5 months after GKRS (range, 1–102 months). Age-associated multivariate analysis indicated that the Karnofsky performance status (KPS), the recursive partitioning analysis (RPA) classification, and the number of treated lesions were significant prognostic factors for overall survival (HR=0.162, p=0.008, HR=0.107, p=0.038, and HR=2.897, p=0.045, respectively). Conclusion GKRS is safe and effective for the management of brain metastasis from gynecologic cancers. The clinical status of the patient is important in determining the overall survival time.
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Affiliation(s)
- Hong Kyung Shin
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hoon Kim
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Heui Lee
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Hyun Cho
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Hoon Kwon
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Woo Roh
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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18
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Surgical management of lung, liver and brain metastases from gynecological cancers: a literature review. GYNECOLOGIC ONCOLOGY RESEARCH AND PRACTICE 2016; 3:7. [PMID: 27330821 PMCID: PMC4912748 DOI: 10.1186/s40661-016-0028-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/03/2016] [Indexed: 12/28/2022]
Abstract
Background The management of patients with recurrent gynecological malignancy is complex, and often contentious. While historically, patients with metastases in the lungs, liver or brain have been treated with palliative intent, surgery is proving to have an increasing role in the management of such patients. Methods In this review article, the surgical management of lung, liver and brain metastases from gynecological cancers is examined. A search of the English language literature over the last 25 years was conducted using the Medline and PubMed databases. Results The results for management of metastases from the endometrium, ovary and cervix to the lung, brain and liver show that surprisingly good long-term survival results can be achieved for resection of metastases from all three organs. Patient selection is critical, and surgery is often used in conjunction with other treatment modalities. Conclusions From this review, it is apparent that surgery should play an increasing role in the management of patients with parenchymal metastases from gynecological cancers. The surgery should ideally be performed in high volume, tertiary centers where there is a committed multi-disciplinary team with the necessary infrastructure to achieve the best possible outcomes in terms of both survival and morbidity.
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19
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Shepard MJ, Fezeu F, Lee CC, Sheehan JP. Gamma knife radiosurgery for the treatment of gynecologic malignancies metastasizing to the brain: clinical article. J Neurooncol 2014; 120:515-22. [PMID: 25129546 DOI: 10.1007/s11060-014-1577-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 08/03/2014] [Indexed: 12/30/2022]
Abstract
Gynecologic malignancies represent some of the commonest causes of cancer in the female population. Despite their overall high prevalence, gynecologic malignancies have seldom been reported to metastasize to the brain. The incidence of gynecologic cancers spreading to the brain has been rising, and the optimal management of these patients is not well defined. A retrospective analysis of patients treated over the past ten years with gamma knife radiosurgery (GKRS) for metastatic gynecologic cancer to the brain was performed. Radiographic treatment response, tumor control, metastatic disease progression and survival data were analyzed. Eight patients with ovarian cancer, six patients with endometrial cancer and two separates who carried a diagnosis of cervical cancer or leiomyosarcoma harbored metastatic disease to the brain that was treated with GKRS. The median dose to the tumor margin was 20 Gy (range 10-22 Gy), and the median maximum radiosurgical dose was 31 Gy (range 16-52.9 Gy). Tumor control was achieved in all patients who had follow up imaging studies. Patients with ovarian cancer had prolonged median survival following GKRS compared to patients with endometrial cancer (22.3 vs 8.3 months, p = 0.02). The patient with cervical cancer survived 8 months following her GKRS in the setting of metastatic brain tumor progression, whereas the patient with leiomyosarcoma passed away within several weeks of treatment secondary to disseminated extracranial primary disease. GKRS is a safe and effective means of achieving intracranial tumor control for patients with gynecologic cancer that has spread to the brain.
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Affiliation(s)
- Matthew J Shepard
- Department of Neurological Surgery, University of Virginia Health System, P.O. Box 800212, Charlottesville, VA, 22908, USA,
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20
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Breast cancer resistance protein (BCRP/ABCG2) and P-glycoprotein (P-GP/ABCB1) restrict oral availability and brain accumulation of the PARP inhibitor rucaparib (AG-014699). Pharm Res 2014; 32:37-46. [PMID: 24962512 DOI: 10.1007/s11095-014-1442-z] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 06/10/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Rucaparib is a potent, orally available, small-molecule inhibitor of poly ADP-ribose polymerase (PARP) 1 and 2. Ongoing clinical trials are assessing the efficacy of rucaparib alone or in combination with other cytotoxic drugs, mainly in breast and ovarian cancer patients with mutations in the breast cancer associated (BRCA) genes. PURPOSE We aimed to establish whether the multidrug efflux transporters ABCG2 (BCRP) and ABCB1 (P-gp, MDR1) affect the oral availability and brain penetration of rucaparib in mice. RESULTS In vitro, rucaparib was efficiently transported by both human ABCB1 and ABCG2, and very efficiently by mouse Abcg2. Transport could be inhibited by the small-molecule ABCB1 and ABCG2 inhibitors zosuquidar and Ko143, respectively. In vivo, oral availability (plasma AUC0-1 and AUC0-24) and brain levels of rucaparib at 1 and 24 h were increased by the absence of both Abcg2 and Abcb1a/1b after oral administration of rucaparib at 10 mg/kg. CONCLUSIONS Our data show to our knowledge for the first time that oral availability and brain accumulation of a PARP inhibitor are markedly and additively restricted by Abcg2 and Abcb1a/1b. This may have clinical relevance for improvement of rucaparib therapy in PARP inhibitor-resistant tumors with ABCB1 and/or ABCG2 expression and in patients with brain (micro)metastases positioned behind a functional blood-brain barrier.
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21
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Pakneshan S, Safarpour D, Tavassoli F, Jabbari B. Brain metastasis from ovarian cancer: a systematic review. J Neurooncol 2014; 119:1-6. [PMID: 24789253 DOI: 10.1007/s11060-014-1447-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 04/13/2014] [Indexed: 11/26/2022]
Abstract
To review the existing literature on brain metastasis (BM) from ovarian cancer and to assess the frequency, anatomical, clinical and paraclinical information and factors associated with prognosis. Ovarian cancer is a rare cause of brain metastasis with a recently reported increasing prevalence. Progressive neurologic disability and poor prognosis is common. A comprehensive review on this subject has not been published previously. This systematic literature search used the Pubmed and Yale library. A total of 66 publications were found, 57 of which were used representing 591 patients with BM from ovarian cancer. The median age of the patients was 54.3 years (range 20-81). A majority of patients (57.3 %) had multiple brain lesions. The location of the lesion was cerebellar (30 %), frontal (20 %), parietal (18 %) and occipital (11 %). Extracranial metastasis was present in 49.8 % of cases involving liver (20.7 %), lung (20.4 %), lymph nodes (12.6 %), bones (6.6 %) and pelvic organs (4.3 %). The most common symptoms were weakness (16 %), seizures (11 %), altered mentality (11 %) visual disturbances (9 %) and dizziness (8 %). The interval from diagnosis of breast cancer to BM ranged from 0 to 133 months (median 24 months) and median survival was 8.2 months. Local radiation, surgical resection, stereotactic radiosurgery and medical therapy were used. Factors that significantly increased the survival were younger age at the time of ovarian cancer diagnosis and brain metastasis diagnosis, lower grade of the primary tumor, higher KPS score and multimodality treatment for the brain metastases. Ovarian cancer is a rare cause of brain metastasis. Development of brain metastasis among older patients and lower KPS score correlate with less favorable prognosis. The more prolonged survival after using multimodality treatment for brain metastasis is important due to potential impact on management of brain metastasis in future.
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Affiliation(s)
- Shabnam Pakneshan
- Department of Neurology, Yale University School of Medicine, 15 York Street, LCI Building, New Haven, CT, 06520, USA,
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22
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Late Isolated Central Nervous System Relapse from Ovarian Serous Adenocarcinoma: A Case Report and Literature Review. Case Rep Obstet Gynecol 2014; 2014:297307. [PMID: 25506007 PMCID: PMC4251821 DOI: 10.1155/2014/297307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 11/04/2014] [Accepted: 11/04/2014] [Indexed: 12/05/2022] Open
Abstract
Central nervous system involvement by ovarian serous adenocarcinoma is rare. We report a case of a 60-year-old woman that developed brain metastasis as isolated site of relapse 4.5 years after a complete resection and adjuvant chemotherapy for a stage Ic disease. She proceeded to a craniotomy with resection of the lesion and, subsequently, to a whole brain radiotherapy. Nineteen months later, she developed carcinomatous meningitis as isolated site of recurrence. Patient was submitted to intrathecal chemotherapy with methotrexate; however, she died from progressive neurologic involvement disease few weeks later.
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23
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Brain metastasis as an initial manifestation of ovarian carcinoma: a case report. Case Rep Med 2012; 2012:735026. [PMID: 23316241 PMCID: PMC3539383 DOI: 10.1155/2012/735026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 12/11/2012] [Indexed: 12/05/2022] Open
Abstract
Brain metastasis is a rare and late manifestation of ovarian carcinoma. A 30-year-old woman initially presenting with neurologic symptoms was later found to have mucinous ovarian carcinoma. The patient had a 6 cm adnexal mass with multiple millimetric brain metastatic lesions. Following a surgical staging laparotomy procedure, the patient received brain irradiation and systemic chemotherapy.
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