Advanced disease, recurrence precede brain metastasis from gynaecologic cancers

Patients with brain metastasis from gynaecologic cancers often present with an advanced stage disease and have had at least one prior recurrence, according to a study. In addition, the presence of an extracranial disease is common at the time of brain metastasis diagnosis.

These findings were recently presented by Dr Sadhvi Batra from the University Hospitals Cleveland Medical Center in Ohio, US, at the 2023 SGO Annual Meeting on Women’s Cancer.

Batra and colleagues conducted this single-centre study to improve understanding of brain metastases in gynaecologic cancers and identify factors that may be associated with survival.

“Prognostication after diagnosis with brain metastasis remains poor and difficult, additionally life-prolonging treatment options for brain metastases from gynaecologic cancers have not been well described,” they said. “Furthermore, the molecular and genetic characteristics unique to brain metastases in gynaecologic cancers remain poorly understood.”

The research team collected retrospective data on 65 patients with a primary diagnosis of gynaecologic cancer who developed brain metastasis from 2001 to 2021. They also performed a survival analysis using Kaplan‒Meier method with differences compared by the log-rank test.

Of the patients, 49 percent had uterine cancer, 34 percent had ovarian cancer, and 17 percent had cervical cancer. Majority of these individuals presented with an advanced disease, and this did not vary by the type of cancer involved (p=0.34). [SGO 2023, abstract 1191]

The median time for brain metastasis development was 19 months for patients with uterine cancer, 36 months for women with ovarian cancer, and 22 months for those with cervical cancer. By the time of diagnosis, 33.8 percent, 38.4 percent, and 27.7 percent of these patients had had a first, second, and third recurrence, respectively.

In terms of overall survival, the median was 3 months for patients with uterine cancer, 5 months for women with ovarian cancer, and 2 months for those with cervical cancer.

Multimodal treatment

“Though brain metastasis from gynaecologic cancers is overall a rare occurrence, there has been a noticeable increase in recent years at our hospitals inpatient service,” the researchers said. “This may be attributed to advances in therapies for gynaecologic malignancies leading to prolonged survival, as well as advances in radiologic imaging allowing clinicians to diagnose brain metastasis more readily.”

According to a 2016 study, the tendency of tumours to metastasize varies from one type to another, while the tendency to develop brain metastasis depends on disease stage, grade, and histology, as well as the genetic profile of the primary tumours. [Open J Obstet Gynecol 2016;6:544-552]

Additionally, the investigators of the said study recommended multimodal treatment to achieve better outcomes in the management of brain metastasis from gynaecologic cancers.

“Given the poor survival in patients with brain metastasis and gynaecologic cancers, future research should ultimately aim to improve life prolonging interventions for this patient population,” said the researchers of the current study.

“Further understanding of the molecular and genetic alterations present in these patients has the potential to identify targets for early diagnosis and effective treatments,” they added.