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1、1Brain Metastases from Epithelial Ovarian Cancer: A Review of the Literature 作者：Dimitrios Pectasides, Melina Pectasides, Theofanis Economopoulos 【关键词】 Brain,metastases,Surgery,Stereotactic,radiosurgery,Whole-brain,radiotherapy,ChemotherapyLEARNING OBJECTIVES After completing this course, the reader
2、will be able to: Select the appropriate treatment strategies for ovarian cancer patients with solitary brain metastases and extracranial disease. Describe the most important prognostic factors for 2ovarian cancer patients with brain metastases. List the diagnostic steps needed to establish the diagn
3、osis of brain metastases in ovarian cancer patients. ABSTRACT Background. Brain metastases from epithelial ovarian cancer (EOC) are rare. This report is based on a review of the literature. Methods and Results. This review summarizes the incidence, clinical features, pathophysiology, and diagnostic
4、evaluation of EOC. The section on current treatment includes a thorough evaluation of the literature, highlights controversies over treatment options, and provides insight into novel approaches. Current treatment options include surgical resection, whole-brain radiation therapy (WBRT), stereotactic
5、radiosurgery, and chemotherapy. Corticosteroids and anticonvulsant medications are commonly used for the palliation of mass effects and seizures, respectively. In the reviewed series, a better outcome was seen following surgical 3resection and WBRT with or without chemotherapy for solitary and resec
6、table brain metastases. Conclusion. The prognosis for patients with brain metastases from EOC is poor. A better outcome might be obtained using multimodality therapy. Because of the small number of patients included in the reported studies, multicenter clinical trials are needed for further investig
7、ation in order to critically evaluate the clear benefit of these treatment options in selected patients. INTRODUCTION Ovarian cancer is a major cause of morbidity and mortality among gynecological malignancies 1. The current standard treatment of epithelial ovarian cancer (EOC) of all histological s
8、ubtypes involves primary optimal debulking surgery followed by cisplatin-based chemotherapy. However, despite the significant advances in surgery and chemotherapy achieved over the past decades, the resulting overall 5-year survival rate in patients presenting with advanced-stage disease remains qui
9、te low, approximately 40%, probably 4because of the lack of effective therapies 25. Brain metastases from EOC are rare and a late manifestation of the disease that occurs in patients with prolonged survival as a result of platinum-based chemotherapy. The incidence of brain metastases from EOC ranges
10、 from 0.29% to 5% 68. Some reports have indicated that the rate is 5% and approaching 12% 911. Several meta-analyses of up to 194 patients have been conducted in an effort to formulate therapeutic guidelines 8, 1214. A review of the English literature dealing with the relatively large series of pati
11、ents with brain metastases from EOC is presented in order to assist the management of this interesting yet rare clinical entity. INCIDENCE In the reviewed series of 22,240 women with EOC, 219 cases with brain metastases were reported. The incidence of brain metastases from EOC is estimated to be 1.0
12、1%, ranging from 0.49% to 2.2% (Table 1). In a large series with brain metastases, the incidence was 6 out of 916 (0.7%) 15 or 13 5out of 740 patients (1.8%) 16. The estimates of the incidence of brain metastases in EOC patients may be considered reliable only in large centers based on records of hu
13、ndreds of treated patients. In a large series that included 4,456 EOC patients over a period of 40 years (19441984), no central nervous system (CNS) metastases were observed before 1968 17. Mayer et al. 18 reported on five cases from 567 autopsies performed on patients with EOC, an incidence of 0.9%
14、. In other autopsy series, the incidence of CNS metastases ranged from 1% (1 out of 86 cases) 19 to 6% (6 out of 100 cases) 20. However, these figures could be underestimates of the true incidence. Many patients, regardless of disease stage at presentation or at follow-up, do not routinely undergo b
15、rain imaging as part of the metastatic workup, given that some lesions remain asymptomatic. Several authors recently have called attention to the rising incidence of EOC metastatic to the brain 7, 8. Other recent studies have reported that the incidence of brain metastases has increased over time to
16、 2%4% 21. In a series of 42, 110, and 52 EOC patients, the incidences of brain metastases were reported to be 7.1% 8, 4.5% 9, and 11.6% 10, respectively. However, those studies only included a 6small number of patients. Some reports have indicated that the rate is 5% and is approaching 12 % 10, 11. A possible explanation for the increased incidence of brain metastases that has been reported during the past three decades is that the
