title: Brain metastases in patients with EOC: Clinico-pathological and prognostic factors. A multicentric retrospective analysis from the MITO group (MITO 19).
abstract: BACKGROUND
  Brain metastases (BM) from epithelial ovarian cancer (EOC) are considered a rare and unfavourable event. There is no consensus regarding the best management of these patients.
  
  
  METHODS
  A multicenter retrospective analysis of patients with BM from EOC treated between 1997 and 2014 in 18 institutions of the MITO (Multicenter Italian Trials in Ovarian cancer) group was conducted. Univariate and multivariate analysis were performed.
  
  
  RESULTS
  A total of 174 women were identified as having BM from EOC. The median time interval between primary diagnosis of EOC and occurrence of BM was 26months (range 2-129months). The median overall survival from primary EOC diagnosis was 48months (95% CI 39.5-56.4months) and from diagnosis of BM was 12months (95% CI 9.6-14.3months). The majority of enrolled women (81.7%) were classified as sensitive to platinum-based chemotherapy. Four variables were significantly associated with poor overall survival in multivariate analysis: multiple BM [HR: 1.86 (95% CI: 1.22-2.84)], presence of extracranial disease [HR: 1.77 (95% CI: 1.11-2.83)] age [HR: 1.74 (95% CI: 1.17-2.59)], and monotherapy [HR: 2.57 (95% CI: 1.64-3.86)]. On the contrary, residual tumor at primary surgery, FIGO stage at primary diagnosis and platinum sensitivity were found to have no significant impact on survival from diagnosis of brain lesions.
  
  
  CONCLUSIONS
  Our results suggest that BM is a rare and late manifestation of EOC, with a 12-month life-span expectation. Multiple approach is a positive independent prognostic factor and should be proposed to carefully selected patients.
authors.affiliation: Department of Gynecological and Obstetrical Sciences and Urological Sciences, University of Rome "Sapienza" Rome, Italy. Electronic address: clamarchetti@libero.it.
authors.forename: Claudia
authors.initials: C
authors.lastname: Marchetti
authors.affiliation: Department of Medicine and Health Science, University of Molise/Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Ferrandina
authors.affiliation: Gynecologic Oncology Unit, University of Bari and Oncology Institute "Giovanni Paolo II", Bari, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Cormio
authors.affiliation: Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Gambino
authors.affiliation: Department of Gynecologic and Urologic Oncology, Fondazione Pascale, National Cancer Institute of Naples, Italy.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Cecere
authors.affiliation: Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy.
authors.forename: Domenica
authors.initials: D
authors.lastname: Lorusso
authors.affiliation: Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: De Giorgi
authors.affiliation: Department of Obstetrics and Gynecology, University Research Hospital "Fondazione IRCCS Policlinico San Matteo" of Pavia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bogliolo
authors.affiliation: Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy; Gynecologic Oncology, S. Maria Hospital, University of Perugia, Terni, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Fagotti
authors.affiliation: Medical Oncology 1, IRCCS Hospital San Martino, Genova, Italy.
authors.forename: Serafina
authors.initials: S
authors.lastname: Mammoliti
authors.affiliation: Medical Oncology Unit, Hospital 'SS. Trinità', Sora, Italy.
authors.forename: Filomena
authors.initials: F
authors.lastname: Narducci
authors.affiliation: Department of Obstetrics and Gynecology, San Raffaele Hospital, Milan, Italy.
authors.forename: Alice
authors.initials: A
authors.lastname: Bergamini
authors.affiliation: Department of Obstetrics and Gynecology, Hospital Cannizzaro, Catania, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Scollo
authors.affiliation: Department of Obstetrics and Gynecology, University of Torino School of Medicine, Torino, Italy.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Biglia
authors.affiliation: Hospital S. Giovanni Calibita Fatebenefratelli Isola Tiberina, Roma, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Breda
authors.affiliation: Oncology Unit, Faenza Hospital (RA) AUSL Romagna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Tamberi
authors.affiliation: Department of Obstetrics and Gynecology, University of Bari, Bari, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Marinaccio
authors.affiliation: Department of Obstetrics and Gynaecology Campus Bio Medico University of Rome, 00128 Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Angioli
authors.affiliation: Department of Gynecological and Obstetrical Sciences and Urological Sciences, University of Rome "Sapienza" Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Salerno
authors.affiliation: Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy.
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Eusebi
authors.affiliation: Gynecologic Oncology Unit, University of Bari and Oncology Institute "Giovanni Paolo II", Bari, Italy.
authors.forename: Vera
authors.initials: V
authors.lastname: Loizzi
authors.affiliation: Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Scambia
authors.affiliation: Department of Gynecological and Obstetrical Sciences and Urological Sciences, University of Rome "Sapienza" Rome, Italy.
authors.forename: Pierluigi Benedetti
authors.initials: PB
authors.lastname: Panici
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000150:complications / Q000556:secondary / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000150:complications / Q000556:secondary / Q000628:therapy*; D016190:Carboplatin / Q000008:administration & dosage; D018269:Carcinoma, Endometrioid / Q000150:complications / Q000556:secondary / Q000628:therapy*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000008:administration & dosage; D003221:Confusion / Q000209:etiology; D016371:Cranial Irradiation; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D059146:Metastasectomy; D008875:Middle Aged; D015999:Multivariate Analysis; D009325:Nausea / Q000209:etiology; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000150:complications / Q000556:secondary / Q000628:therapy*; D019635:Neurosurgical Procedures; D010051:Ovarian Neoplasms / Q000473:pathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology; D015996:Survival Rate; D014717:Vertigo / Q000209:etiology; D014839:Vomiting / Q000209:etiology
chemical_list: D016190:Carboplatin; D002945:Cisplatin
keywords: Brain metastasis; Ovarian cancer; Platinum sensitivity