Brain recurrences in patients with ovarian cancer: report of 12 cases and review of the literature.

The aim of the investigation was to assess 12 cases of brain recurrences among ovarian cancer patients who had undergone surgery followed by platinum-based chemotherapy. Brain lesions were the first recurrence in 4 (33%) patients, the second recurrence in 7 (58%), and the fourth recurrence in one patient. The median time from ovarian cancer diagnosis to brain metastasis detection was 33.5 months (range, 13.5-86.5 months), brain metastases were multiple in 6 (50%) cases, and extra-cranial disease was present in 7 (58%) cases. Brain recurrence was symptomatic in 10 patients and the clinical presentation included impaired deambulation, extremity weakness, seizure, headache, nausea/vomiting and visual disturbance. Out of the 6 patients with single brain metastases, one underwent surgery, one had surgical excision followed by whole brain irradiation, 3 patients received stereotactic radiotherapy (followed by chemotherapy for coexistent extra-abdominal recurrence in one), and one had only symptomatic treatment. Out of the 6 patients with multiple brain metastases, four received whole brain irradiation (followed by chemotherapy for concomitant extra-cranial recurrence in one case), one patient had gamma-knife irradiation of three cerebral lesions (followed by chemotherapy for concurrent abdominal recurrence), and one patient had only symptomatic treatment. The median overall survival from diagnosis of brain metastasis was 8.3 months (range, 1-28 months), and it was not related to the number of brain metastases (multiple versus single), presence or absence of extra-cranial disease, or interval between ovarian cancer diagnosis and brain metastasis detection (<33.5 months versus > or =33.5 months). In conclusion, brain metastasis from ovarian cancer can represent a late manifestation of the disease, associated with a very poor prognosis.