Brain metastases in patients with EOC: clinico-pathological and prognostic factors. A multicentric retrospective analysis from the MITO group (MITO 19)

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. Amulticenter retrospective analysis of patients with BMfromEOC treated between 1997 and 2014 in 18 institutions of theMITO (Multicenter Italian Trials in Ovarian cancer) groupwas conducted. Univariate and multivariate analysis were performed. Results. A total of 174womenwere identified as having BMfromEOC. Themedian time interval between primary diagnosis of EOC and occurrence of BMwas 26 months (range 2–129months). The median overall survival fromprimary EOC diagnosiswas 48months (95% CI 39.5–56.4months) and fromdiagnosis of BMwas 12months (95% CI 9.6–14.3 months). The majority of enrolled women (81.7%) were classified as sensitive to platinum-based chemotherapy. Four variableswere significantly associatedwith poor overall survival inmultivariate 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 platinumsensitivitywere 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.