Prognostic impact of platinum sensitivity in ovarian carcinoma patients with brain metastasis

• Published in: BMC cancer Vol. 19; no. 1; p. 1194
• Main Authors: da Costa, Alexandre André Balieiro Anastácio, Dos Santos, Elizabeth Santana, Cotrim, Deborah Porto, Pandolfi, Natasha Carvalho, Cesca, Marcelle Goldner, Mantoan, Henrique, Sanches, Solange Moraes, Ribeiro, Adriana Regina Gonçalves, de Brot, Louise, Bonvolim, Graziele, Sanematsu, Paulo Issamu, de Souza, Ronaldo Pereira, Maya, Joyce Maria Lisboa, de Souza Castro, Fabrício, da Nogueira Silveira Lima, João Paulo, Chen, Michael Jenwel, Guimarães, Andrea Paiva Gadelha, Baiocchi, Glauco
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 05-12-2019; BioMed Central; BMC
• Subjects: Aged; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - therapeutic use; Brain cancer; Brain metastasis; Brain Neoplasms - secondary; Brain Neoplasms - therapy; Brain tumors; Breast cancer; Cancer metastasis; Cancer patients; Cancer research; Cancer therapies; Carcinoma; Care and treatment; Chemotherapy; Cranial Irradiation; Development and progression; Diagnosis; Female; Gynecology; Humans; Medical prognosis; Medical records; Medical research; Melanoma; Metastases; Metastasis; Middle Aged; Nervous system; Neurosurgical Procedures; Operating systems (Software); Ovarian cancer; Ovarian carcinoma; Ovarian Neoplasms - drug therapy; Patients; Platinum; Platinum Compounds - administration & dosage; Platinum Compounds - therapeutic use; Platinum sensitivity; Prognosis; Prognostic factors; Radiation therapy; Radiotherapy; Regression Analysis; Retrospective Studies; Sample Size; Statistical analysis; Surgery; Survival; Survival Analysis; Treatment Outcome; Tumors; Values; Platinum sensitivity; Brain metastasis; Prognostic factors; Ovarian cancer
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-019-6382-x

Brain metastasis (BM) is a rare event in ovarian cancer patients. The current prognostic scores that have been used for other tumors do not account for specific characteristics of ovarian cancer, such as platinum sensitivity.
This retrospective cohort study examined patients with ovarian carcinoma and BM who were treated at a single institution from January 2007 to December 2017. Clinical data on the diagnosis of BM and follow-up were collected. Cox regression was used to evaluate prognostic factors for overall survival (OS).
Of 560 patients, 26 presented with BM. Eight patients were treated with surgery, 15 with whole-brain radiotherapy (RT), and 5 with stereotactic RT, and 4 patients received systemic treatment at the diagnosis of BM. The median OS was 10.8 months. The following factors were associated with OS: platinum-sensitive recurrence (HR 0.34, 95% CI 0.12-0.99; p = 0.049), higher number of previous treatment lines (HR 1.57, 95% CI 1.12-2.19; p = 0.008), ECOG performance status (HR 2.52, 95% CI 1.24-5.09; p = 0.010), and longer interval from initial diagnosis to BM (p = 0.025). Notably, the number of brain metastasis, the largest tumor size, and progression outside of the CNS were not related to survival. Platinum sensitivity was not associated with any of the classic prognostic factors in brain metastasis patients such as number or size of brain metastasis or disease progression outside the CNS strengthening the hypothesis of the importance of platinum sensitivity to the prognosis of ovarian cancer patients with BM.
The factors related to the biological behavior of the ovarian cancer such as platinum sensitivity at the time of BM diagnosis, fewer number of previous treatment lines and interval from initial diagnosis were associated with survival in ovarian cancer patients with BM, while factors that are usually related to survival in BM in other cancers were not associated with survival in this cohort of ovarian cancer patients. The small number of patients did not allow us to exclude the prognostic role of these former factors that were not associated with survival in the present cohort.