title: Epithelial ovarian cancer metastasizing to the brain: a late manifestation of the disease with an increasing incidence.
abstract: OBJECTIVE
  We present the Royal Marsden Hospital experience of cerebral metastases from primary epithelial ovarian carcinoma (EOC) over the last 20 years and examine the evidence for an increasing incidence of EOC metastasizing to this site.
  
  
  METHODS
  A total of 3,690 women with EOC were seen at the Royal Marsden Hospital from 1980 to 2000. Eighteen of these patients developed cerebral metastases.
  
  
  RESULTS
  Median age at diagnosis of EOC was 52 years (range, 39 to 67). All patients received at least one line of platinum-based chemotherapy; 56% (10 of 18) received more than one line of treatment; 17% (three of 18), two lines; 11% (two of 18), three lines; and 28% (five of 18), four lines. The median treatment interval between each line of chemotherapy was 12, 18, and 4 months. The median interval between diagnosis and CNS relapse was 46 months (range, 12 to 113), in comparison with 5 and 7.5 months for hematogenous relapse in lung or liver, respectively (P <.001). The incidence of CNS metastases in our population from 1980 to 1984 was 0.2%; from 1985 to 1989, 0%; from 1990 to 1994, 0.3%; and from 1995 to 1999, 1.3% (P <.001). An analysis of data from the literature also suggests that the incidence of cerebral metastases from EOC has increased over time.
  
  
  CONCLUSIONS
  CNS metastases in EOC are a rare and late manifestation of the disease, occurring in patients with a prolonged survival caused by repeated chemosensitive relapses. An analysis of our data and the data from the literature suggests that the incidence of metastasis at this site in patients with EOC is increasing.
authors.affiliation: Gynaecology Unit, Royal Marsden Hospital, London, United Kingdom.
authors.forename: Desiree F
authors.initials: DF
authors.lastname: Kolomainen
authors.forename: James M G
authors.initials: JM
authors.lastname: Larkin
authors.forename: Mohammad
authors.initials: M
authors.lastname: Badran
authors.forename: Roger P
authors.initials: RP
authors.lastname: A'Hern
authors.forename: D Michael
authors.initials: DM
authors.lastname: King
authors.forename: Cyril
authors.initials: C
authors.lastname: Fisher
authors.forename: Jane E
authors.initials: JE
authors.lastname: Bridges
authors.forename: Peter R
authors.initials: PR
authors.lastname: Blake
authors.forename: Desmond P J
authors.initials: DP
authors.lastname: Barton
authors.forename: John H
authors.initials: JH
authors.lastname: Shepherd
authors.forename: Stanley B
authors.initials: SB
authors.lastname: Kaye
authors.forename: Martin E
authors.initials: ME
authors.lastname: Gore
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000556:secondary*; D002277:Carcinoma / Q000188:drug therapy / Q000556:secondary*; D018572:Disease-Free Survival; D019008:Drug Resistance, Neoplasm; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000473:pathology*; D012189:Retrospective Studies