Journal of Neuro-Oncology

Prognostic factors for brain metastasis in women presenting cervical cancer

Although rare, brain metastases (BM) from cervical cancer (CC) are highly lethal. Adequate patient selection for specific treatments can improve survival rates in patients afflicted by this condition. This study aimed to describe the characteristics of CC patients who developed BM and overall survival-associated factors. Brain metastasis impact on the overall survival was assessed as a secondary objective. This assessment comprises a retrospective cohort study on 3394 women presenting CC diagnosed between January 2010 and December 2017 at a single referral center. Incident BM cases were included. Descriptive statistics were calculated. Kaplan-Meier curves were used for the survival analysis and a Cox proportional hazards regression model was applied to explore the risk of death according to the analyzed independent variables. A total of 48 incident BM cases were identified. The median time between CC diagnosis and BM development was 1.5 years. Headaches (29.2%), dizziness/altered balance (29.2%), vertigo (29.2%) and motor disturbances (25.0%) were the most common signs and symptoms at presentation. Median overall survival after BM diagnosis was of 1.6 months (95% CI 0.9-2.3) while in the group of women without BM it was 5.5 years (95% CI 4.9-6.1). Concerning the Cox multivariate analysis, presenting one extracerebral metastases site (HR 2.8; 95% CI 1.3-6.2; p = 0.009) and receiving supportive treatment (HR 13.7; 95% CI 3.1-60.5; p 0.001) were independently associated with the risk of death. The median survival of women with BM following CC was poor. Women without extracerebral metastases and undergoing multimodal treatment displayed better overall survival rates.

Brain metastases from ovarian cancer: neuroradiological profile and survival overview of neurosurgical cases

This study aims to identify the radiological features of brain metastases (BM) from ovarian cancer (OC) and correlate them to clinical and genetic data. Additionally, the impact of neurosurgery on patient survival is evaluated. A single-center, retrospective, observational study was conducted, involving 106 patients with BM from OC. Neuroradiological imaging was available for 66 patients. The data collected were analyzed using linear correlation and ANOVA tests and multivariable Cox proportional hazards regression for survival analysis. Survival was assessed using Kaplan-Meier curves. The most prevalent histological subtypes were high grade serous (90%) OC. The main neuroradiological feature was necrosis (79%). BM were multiple in 56% of cases, with a prevalent distribution in the cerebral hemispheres (80.30%). Additional neuroradiological features included a volume greater than 1000 mm³ (71%), hemosiderin deposits on SWI (67%), abundant perilesional edema (53%), and the presence of hemorrhage (15%). The mean apparent diffusion coefficient (ADC) value of BM was 781.5 × 10^-6 mm²/s, while relative cerebral volume (rCBV) was lower in patients with posterior fossa BM (p = 0.049). Neurological symptoms were present in 39% of cases, and a linear correlation was identified between neurological symptoms and both tumor volume (p = 0.0008) and the presence of necrosis (p = 0.04). The BRCAm was associated to longer survival (p = 0.04) and was associated with less perilesional edema (OR = 0.145, CI: 0.027-0.776). The Kaplan-Meier analysis showed an overall survival (OS) of 46 months in BRCAwt patients who underwent neurosurgery, vs. 37 months in patients who did not (p = 0.03). Cox analysis identified BRCAm status, performance status, post-BM chemotherapy, and CNS-only disease as independent predictors of better survival; surgery was not significant. The current study supports the established protective value of the BRCA mutation and suggests that neurosurgical treatment of BM after a comprehensive evaluation may improve survival, even in BRCAwt patients. The critical need for early detection of BMs that are appropriate for surgical intervention is highlighted, as timely action can greatly improve patient outcomes.