Cerebral metastasis from ovarian cancer treated with a multidisciplinary approach. Case report and review of literature

Brain metastases from ovarian cancer are rare. A review of five autopsy studies reported brain metastases in 4% of 712 patients who died with a diagnosis of ovarian cancer. The prognosis is very poor and a consensus on the standard treatment is not available. We report the case of a patient who developed a solitary brain metastasis as single evidence of relapse, 26 months after the first diagnosis of ovarian cancer. A temporo-parietal craniotomy with excision of the mass and whole brain radiotherapy were performed. The patient is free of disease five months after radiotherapy completion. Also in patients suffering from neoplasms that rarely metastasize to CNS, a careful clinical examination may help to diagnose uncommon sites of disease relapse.

Ovarian cancer; Cerebral metastasis; Treatment

[I] Reed E., Zerbe C.S., Brawley 0.W., Bicher A., Steinberg S.M.: "Analysis of autopsy evaluation of ovarian cancer patients treated at the National Cancer Institute, 1972-1988". Am. J. Clin. Oncol., 2000, 23, 107.

[2] Kolomainen D.F., Larkin J.M., Badran M., A'Hern R.P., King D.M., Fischer C. et al.: "Epithelial ovarian cancer metastasizing to the brain: a late manifestation of the disease with an increasing incidence". J. Clin. Oncol., 2002, 20, 982.

[3] Com B.W., Greven K.M., Randall M.E., Wolfson A.H., Kim R.Y., Lanciano R.M.: "The efficacy of cranial irradiation in ovarian cancer metastatic to the brain: analysis of 32 cases". Obstet. Gynecol., 1995, 86, 955.

[4] Patchell R.A., Cirrincione C., Thaler H.T., Galicich J.H., Kim J.H., Posner J.B.: "Single brain metastases: surgery plus radiation or radiation alone". Neurology, 1986, 36, 447.

[5] Vecht C.J., Haaxma-Reiche H., Noordijk E.M., Padberg G.W., Voormolen J.H., Hoekstra F.H.: "Treatment of single brain metastasis: radiotherapy alone or combined with neurosurgery?". Ann. Neural., 1993, 33, 583.

[6] Mintz A.H., Kestle J., Rathbone M.P., Gaspar L., Hugenhomtz H., Fisher B.: "A randomised trial to assess the efficacy of surgery in addition to radiotherapy in patients with a single cerebral metastasis". Cancer, 1996, 78, 1470.

[7] Rodriguez G.C., Soper J.T., Berchuck A.: "Improved palliation of cerebral metastases in epithelial ovarian cancer using a combined modality approach including radiation therapy, chemotherapy and surgery". J. Clin. Oncol., 1992, 10, 1553.

[8] Cormio G., Maneo A., Parma G., Pittelli M.R., Miceli D.M., Bonazzi C.: "Central nervous metastases in patients with ovarian carcinoma". Ann. Oncol., 1995, 6, 571.

[9] Geisler J.P., Geisler H.E.: "Brain metastases in epithelial ovarian carcinoma". Gynecol. Oncol., 1995, 57, 246.

[10] Kaminsky-Forrett M.C., Weber B., Conroy T., Spaeth D.: "Brain metastases from epithelial ovarian carcinoma". Int. J. Gynecol. Cancer, 2000, 10, 366.

[11] Cooper K.G., Kitchener H.C., Parkin D.E.: "Cerebral metastases from epithelial ovarian carcinoma treated with carboplatin". Gynecol. Oncol., 1994, 55, 318.

[12] Cormio G., Gabriele A., Maneo A., Zanella G., Bonazzi C., Landoni F.: "Complete remission of brain metastases from ovarian carcinoma with carboplatin". Eur. J. Obstet. Gynecol. Reprod. Biol., 1998, 78, 91.

[13] Kawana K., Yoshikawa H., Yokota H., Onda T., Nakagawa K., Tsutsumi O. et al.: "Successful treatment of brain metastases from ovarian cancer using gamma-knife radiosurgery". Gynecol. Oncol., 1997, 65, 357.

[14] Com B.W., Mehta M.P., Buatti J.M., Wolfson A.H., Greven K.M., Kim R. Y. et al.: "Stereotactic irradiation. Potential new treatment method for brain metastases resulting from ovarian cancer". Am. J. Clin. Oncol., 1999, 22, 143.