Central Nervous System

PV 02 - Poster Viewing Q&A - Session 2

MO_2_2154 - Palliative Radiation Therapy for Brain Metastasis from Gynecological Cancer.

Monday, September 16
10:45 AM - 12:00 PM
Location: ASTRO Innovation Hub

Palliative Radiation Therapy for Brain Metastasis from Gynecological Cancer.
A. C. C. Ahumada Pamanes, S. I. Perez Alvarez, C. H. Flores Balcazar, G. E. Trejo Duran, A. Mota, and J. C. Rodríguez Rosas; National Cancer Institute, Mexico City, DF, Mexico

Purpose/Objective(s): Brain metastases (BM) in gynecologic cancer (GC) is unusual (0.3-2%). Prognosis is not clear, however increase in time from primary diagnosis to BM (TPD-BM) and treatment free interval (TFI) could be associated with better overall survival (OS). Primary objective: report incidence of BM in GC. Secondary objectives: describe presentation, RT and OS from GC diagnosis and from BM (OS-BM).

Materials/Methods: Retrospective study at 1 single institution. Review of medical records of patients (pts) with GC (2005-2017). TFI was defined as the time from the last treatment before diagnosis of BM to diagnosis of BM. Brain image review. Statistical analysis with statistical analysis software. Results: 109 pts with BM in 10,382 pts with GC (1.04%): 0/104 vaginal, 2/175 vulvar (1.1%), 25/3119 uterine (0.8%), 32/4468 cervical (0.7%) and 48/2516 ovarian cancer (1.9%). FIGO 2009 stage at diagnosis of primary: 8% I-II, 26% III, 10% IVA,56% IVB. Median time since GC diagnosis and BM were 16 months (0-111). Median age at diagnosis of BM was 52 years (17-78). BM synchronic with primary in 21.3%. At BM diagnosis, 94% had neurological symptoms (64% headache, 21% cerebellar, 29% paresis). Median time from symptoms to BM was 1 week (0-15); 18% had primary GC controlled, and 54% recurrence/persistence. Median ECOG: 2 (1-4). Median BM scales scores: RPA 2 points (1-3), GPA 1.5 points (9-3). BM image: MRI (66%), CT (49%), PET/CT (4%). 60% with 1 BM, 11.2% had 2-3 BM and 29% ≥4 BM. Supratentorial BM in 78%, infratentorial in 4% and 19% both. Median size of larger BM was 30 mm (3-120), bleeding in 5% and 10% leptomeningeal carcinomatosis. 9 pts were surgically resected. Whole-brain RT (WBRT) was offered to 100 pts (92%), in 91 (84%) complete course of RT. RT dose: 86% 30Gy/10, 13% 20Gy/5. After brain RT, 69% pts showed subjective complete/partial recuperation, 24% stable and 7% deterioration. 7 pts required re-irradiation (4 WBRT and 3 conformal RT). With a median follow-up after diagnosis of BM of 8 months (1-37), 1-, 2- and 5-year OS was 70%, 53% and 19.2%, respectively. 1- and 2-year OS-BM was 33% and 19%. 1- and 2-year OS was better in ovarian (38.7% and 26%) vs cervical/uterine cancer (27% and 12%, p=0.04). 1- and 2-year OS was better with 1-3 BM (37% and 21%) vs ≥4 BM (26% and 16%, p=0.043). 1- and 2-year OS was better with ≥6 months of TPD-BM (43% and 28% if ≥12 vs 17% and 6% if <12 months, p=0.019). 1- and 2-year OS was better for pts with ≥6 (54.5% and 36.4%) vs <6 months of TFI (22% and 10%, p=0.002). Univariate analysis: ovarian primary GC (p=0.036) was associated with better OS; neither age, number of BM, extracranial metastases, ECOG, TPD-BM of ≥12 months nor TFI ≥12 months. In logistic regression analysis primary site (p=0.01) and TFI >12 months (p=0.03) were associated with better OS.

Conclusion: BM from GC were unusual (1%). Most are symptomatic, multiple and with supratentorial localization. Despite palliative RT, OS after diagnosis of the BM is low (1-year OS 33%). TFI ≥12 months and ovarian primary are associated with better OS.

Author Disclosure: A.C. Ahumada Pamanes: None. S.I. Perez Alvarez: None. G.E. Trejo Duran: None. A. Mota: None. J. Rodríguez Rosas: None.

Ana Carolina Ahumada Pamanes, MD

Instituto Nacional de Cancerologia


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MO_2_2154 - Palliative Radiation Therapy for Brain Metastasis from Gynecological Cancer.

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