Central nervous system metastasis in gynecologic cancer: symptom management, prognosis and palliative management strategies.
BACKGROUND
CNS metastasis (CNSmet) with gynecologic malignancy (GM) is associated with poor prognosis and symptom burden. Two prognostic indices, the recursive partitioning analysis (RPA) and graded prognostic assessment (GPA), used in other solid tumors to guide intervention options were evaluated among GM patients.


METHODS
Retrospective chart review was performed to identify patients with primary GM diagnosed with CNSmet from 2005-2014. RPA and GPA were applied and evaluated for goodness of fit. Long-term survivors (LTS) were those with survival time from CNSmet ≥9 months.


RESULTS
35 patients were identified with median age of 62 years (range, 41-78). The majority had ovarian cancer (54%). Median survival was 4.5 months (0.1-25.9), and median time from initial diagnosis was 2.6 years (0-19.6). Presenting symptoms varied but headache (57%) and altered mental status (23%) were most common. 37% had a solitary CNS lesion, 31% had 2-8, and 31% >8. 57% were treated with WBRT, 14% with stereotactic radiosurgery (SRS), and 20% with combinations of treatments, and 2 elected for hospice. 27% (9/33) of the patients were LTS. The GPA was not significantly associated with patient outcome (p=0.46). The RPA predicted time to death (p=.0010).


CONCLUSIONS
Prognostic indices used to guide therapeutic interventions perform poorly in GM. Detection and aggressive symptom management are critical in maintaining QOL. Multidisciplinary consultation is critical to optimize outcomes and symptom control.
Division of Gynecologic Oncology, University of Oklahoma, Stephenson Cancer Center, 800 NE 10th Street Suite 5050, Oklahoma City, OK 73104, United States. Electronic address: Adam-walter@ouhsc.edu.
Adam C
AC
Walter
Division of Gynecologic Oncology, University of Oklahoma, Stephenson Cancer Center, 800 NE 10th Street Suite 5050, Oklahoma City, OK 73104, United States.
Camille C
CC
Gunderson
Division of Biostatistics, University of Oklahoma, 801 NE 13th Street, Oklahoma City, OK 73126, United States.
Sara K
SK
Vesely
Division of Radiation Oncology, University of Oklahoma, Stephenson Cancer Center, 800 NE 10th Street Suite L100, Oklahoma City, OK 73104, United States.
Ozer
O
Algan
Department of Neurosurgery, University of Oklahoma, 1000 N. Lincoln Boulevard Suite 4000, Oklahoma City, OK 73104, United States.
Michael
M
Sughrue
Division of Gynecologic Oncology, University of Oklahoma, Stephenson Cancer Center, 800 NE 10th Street Suite 5050, Oklahoma City, OK 73104, United States.
Katrina N
KN
Slaughter
Division of Gynecologic Oncology, University of Oklahoma, Stephenson Cancer Center, 800 NE 10th Street Suite 5050, Oklahoma City, OK 73104, United States.
Kathleen N
KN
Moore
D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000150:complications / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D003661:Decision Support Techniques; D005260:Female; D005833:Genital Neoplasms, Female / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D017051:Hospice Care; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D011379:Prognosis; D016634:Radiosurgery; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016896:Treatment Outcome
CNS; Gynecologic; Metastasis; Palliation; Symptoms