Rodriguez G C, Soper J T, Berchuck A, Oleson J, Dodge R, Montana G, Clarke-Pearson D L
Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710.
J Clin Oncol. 1992 Oct;10(10):1553-60. doi: 10.1200/JCO.1992.10.10.1553.
Recent reports suggest an increasing incidence of CNS metastases in patients with ovarian cancer. We reviewed our experience in the management of brain metastases from ovarian carcinoma and merged our results with those of several other series reported in the literature to determine prognostic factors and the role of chemotherapy, radiation therapy, and surgery.
From 1977 to 1990, 15 of 795 patients who were treated for epithelial ovarian cancer at Duke University developed brain metastases. Fourteen of the patients were treated for their brain metastases; this included radiation therapy (RT; four), surgery and RT (one), RT and systemic chemotherapy (six), and all three treatment modalities (three). A meta-analysis was performed that combined the data from the current series with those of several recent clinical series that reviewed patients with brain metastases from ovarian carcinoma (67 patients total) to elucidate the impact of treatment and extent of disease on survival.
In the current series, median survival (MS) after the diagnosis of brain metastases was 9 months. For the combined series, MS was 5 months. Thirteen patients who were treated with whole-brain RT and systemic chemotherapy (MS, 7 months), 10 patients who were treated with RT and surgery (MS, 10 months), and nine patients who were treated with all three modalities (MS, 16.5 months) had significantly longer survival than 19 patients who were treated with RT alone (MS, 3 months) (P = .05, P = .01, and P < .001, respectively). In a multivariate analysis, the only variable that provided prognostic information was treatment, namely the addition of systemic chemotherapy or surgery to RT for the treatment of brain metastases.
Multimodal treatment of patients with brain metastases from ovarian cancer can result in significant palliation.
近期报告显示卵巢癌患者中枢神经系统转移的发生率呈上升趋势。我们回顾了我们在卵巢癌脑转移治疗方面的经验，并将我们的结果与文献中报道的其他几个系列的结果相结合，以确定预后因素以及化疗、放疗和手术的作用。
1977年至1990年，在杜克大学接受上皮性卵巢癌治疗的795例患者中有15例发生了脑转移。其中14例患者接受了脑转移治疗；这包括放射治疗（RT；4例）、手术加RT（1例）、RT加全身化疗（6例）以及所有三种治疗方式（3例）。进行了一项荟萃分析，将本系列的数据与最近几个临床系列的数据相结合，这些系列回顾了卵巢癌脑转移患者（共67例），以阐明治疗和疾病范围对生存的影响。
在本系列中，脑转移诊断后的中位生存期（MS）为9个月。对于合并系列，MS为5个月。接受全脑RT和全身化疗的13例患者（MS，7个月）、接受RT和手术的10例患者（MS，10个月）以及接受所有三种治疗方式的9例患者（MS，16.5个月）的生存期明显长于仅接受RT治疗的19例患者（MS，3个月）（P分别为.05、.01和<.001）。在多变量分析中，唯一提供预后信息的变量是治疗，即在治疗脑转移时在RT基础上加用全身化疗或手术。
对卵巢癌脑转移患者进行多模式治疗可显著缓解症状。
