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|Year : 2019 | Volume
| Issue : 6 | Page : 1437-1438
Commentary on Brain Metastasis from Ovarian Carcinoma: Evaluation of Prognostic Factors and Treatment
Aliasgar Moiyadi, Salman Shaikh
Department of Neurosurgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
|Date of Web Publication||20-Dec-2019|
Dr. Aliasgar Moiyadi
Department of Neurosurgery, Tata Memorial Hospital, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Moiyadi A, Shaikh S. Commentary on Brain Metastasis from Ovarian Carcinoma: Evaluation of Prognostic Factors and Treatment. Neurol India 2019;67:1437-8
Brain metastases from ovarian cancers are extremely rare, and the incidence is probably vastly underreported due to the absence of routine brain imaging even in disseminated ovarian cancers. Wohl et al. are to be commended for addressing this rare group of metastases.
Ovarian cancers are generally advanced at the time of diagnosis (FIGO stage III and IV). Though the brain is not a common site of metastases, this advanced stage cohort is the subset that is most likely to have associated brain metastases. This is reflected in the present study, where almost half of the cases were disseminated, to begin with. Mentioning that the denominator of their sample would have added more value to this article since it would help establish an incidence metric for brain metastases from ovarian cancers. Although brain metastasis remains a rare occurrence in ovarian cancers, the incidence is higher than that seen in the rest of the female genital tract malignancies put together. As with many other cancers, with improvements in the treatment of the primary disease (especially in the post-platinum based chemotherapy era for ovarian cancers) leading to prolongation of survival coupled with improving detection methods, the incidence of brain metastases is increasing. Whether this case is selected as the kind which eventually gets included in the brain metastases series, yet remains difficult to be determined.
Most brain metastases in ovarian cancers are metachronous with intervals from initial diagnosis ranging from 1–4 years. Interestingly in this study by Wohl et al., the disease-free interval was shorter (24 months vs 44 months, [Table 2] from Whol et al.) for the survivors compared to those that died. However, this is most likely the result indicating a small number of survivors.
Serum CA-125 level is a reliable tumor marker of ovarian cancer. However, in patients with brain metastasis, even though there are a few series that show raised values at the time of diagnosis, in the majority of the patients, it has not been proven to be a reliable marker of brain metastasis. Wohl et al. did not report on this, and it may have been pertinent to describe their findings in this respect.
The RTOG recursive partitioning analysis index (RPA) and more recently, the graded prognostic assessment (GPA) index have been used in most brain metastases studies to analyze the various prognostic factors. Due to the rarity of brain metastases in ovarian cancers, this has not found much application in most series of ovarian cancers. Nevertheless, the present study shows that solitary brain metastases and combined modality treatment (surgery with radiation) favourably influence overall survival and progression-free survival, respectively. This again resonates with the overall understanding of brain metastases and the changing paradigms in treatment. Surprisingly, however, they did not find the presence of systemic disease to be a poor prognostic factor, and this could reflect the relative efficacy of systemic therapies in ovarian cancers with extracranial metastases.
A systematic review of 57 similar studies and 591 patients by Pakneshan et al. in 2014, confirmed that survival is related to the patient's age, performance status, and absence of multiple intracranial metastases. These findings are consistent with those reported in this series. More systematic reporting of data from larger patient cohorts will clarify decision-making algorithms in the future.
| » References|| |
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Ogawa K, Yoshii Y, Aoki Y, Nagai Y, Tsuchida Y, Toita T, et al
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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.