title: Radiation therapy for epithelial ovarian cancer brain metastases: clinical outcomes and predictors of survival.
abstract: BACKGROUND
  Brain metastases (BM) and leptomeningeal disease (LMD) are uncommon in epithelial ovarian cancer (EOC). We investigate the outcomes of modern radiation therapy (RT) as a primary treatment modality in patients with EOC BM and LMD.
  
  
  METHODS
  We evaluated 60 patients with EOC treated at our institution from 1996 to 2010 who developed BM. All information was obtained from chart review.
  
  
  RESULTS
  At EOC diagnosis, median age was 56.1 years and 88% of patients were stage III-IV. At time of BM diagnosis, 46.7% of patients had 1 BM, 16.7% had two to three, 26.7% had four or more, and 10% had LMD. Median follow-up after BM was 9.3 months (range, 0.3-82.3). All patients received RT, and 37% had surgical resection. LMD occurred in the primary or recurrent setting in 12 patients (20%), 9 of whom received RT. Median overall survival (OS) after BM was 9.7 months for all patients (95% CI 5.9-13.5), and 16.1 months (95% CI 3.8-28.3) in patients with one BM. On multivariate analysis, Karnofsky performance status less than 70 (hazard ratio [HR] 2.86, p = 0.018), four or more BM (HR 3.18, p = 0.05), LMD (HR 8.22, p = 0.013), and uncontrolled primary tumor (HR 2.84, p = 0.008) were significantly associated with inferior OS. Use of surgery was not significant (p = 0.31). Median central nervous system freedom from progression (CNS-FFP) in 47 patients with follow-up was 18.5 months (95% CI, 9.3-27.9). Only four or more BM (HR 2.56, p = 0.04) was significantly associated with poorer CNS-FFP.
  
  
  CONCLUSIONS
  Based on our results, RT appears to be an effective treatment modality for brain metastases from EOC and should be routinely offered. Karnofsky performance status less than 70, four or more BM, LMD, and uncontrolled primary tumor predict for worse survival after RT for EOC BM. Whether RT is superior to surgery or chemotherapy for EOC BM remains to be seen in a larger cohort.
authors: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, USA. teckies@mskcc.org
authors: Sewit
authors: S
authors: Teckie
authors: Vicky
authors: V
authors: Makker
authors: Viviane
authors: V
authors: Tabar
authors: Kaled
authors: K
authors: Alektiar
authors: Carol
authors: C
authors: Aghajanian
authors: Martee
authors: M
authors: Hensley
authors: Kathryn
authors: K
authors: Beal
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality* / Q000532:radiotherapy* / Q000556:secondary*; D000077216:Carcinoma, Ovarian Epithelial; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000401:mortality* / Q000473:pathology* / Q000532:radiotherapy*; D010051:Ovarian Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000532:radiotherapy*; D012307:Risk Factors; D016896:Treatment Outcome