LeRoux P D, Berger M S, Elliott J P, Tamimi H K
Department of Neurosurgery, University of Washington Medical Center, Seattle 98195.
Cancer. 1991 Apr 15;67(8):2194-9. doi: 10.1002/1097-0142(19910415)67:8<2194::aid-cncr2820670832>3.0.co;2-#.
Apart from choriocarcinoma, involvement of the central nervous system (CNS) by gynecologic malignancy is rare. A 10-year retrospective review at the University of Washington Medical Center (Seattle, WA) and Swedish Hospital and Medical Center Tumor Registry (Seattle, WA) identified 14 patients with cerebral metastases from ovarian carcinoma. Median age at diagnosis of cerebral metastases was 52.5 years. Median interval from the diagnosis of ovarian carcinoma to the diagnosis of CNS metastases was 14.5 months. Seven patients had received cisplatin therapy before CNS relapse. Seven patients underwent second-look procedures before developing CNS metastases; in three, results were negative. Eight patients had evidence of extraperitoneal spread to other sites at the time of CNS relapse. Clinical manifestations included motor weakness, seizures, headache, confusion, and speech disturbance. All lesions were contrast enhancing on computed tomography (CT) scans and were located in the cerebral hemispheres. Nine patients had single lesions, five of whom underwent surgical resection of the lesion with histologic confirmation of metastases from the primary site. Median survival was 2 months in patients receiving radiation therapy alone and 17 months in patients who received surgery and radiation. Median survival of the entire series was 3 months. The presence of multiple cerebral metastases or evidence of extraperitoneal spread elsewhere in the body was adversely associated with survival. The prognosis of patients with cerebral metastases from ovarian carcinoma appears poor. However, early diagnosis by routine CT scanning followed by surgical resection and radiation may improve overall survival in a select group of patients.
除绒毛膜癌外，妇科恶性肿瘤累及中枢神经系统（CNS）的情况较为罕见。华盛顿大学医学中心（华盛顿州西雅图）以及瑞典医院和医疗中心肿瘤登记处（华盛顿州西雅图）进行的一项为期10年的回顾性研究，确定了14例卵巢癌脑转移患者。脑转移诊断时的中位年龄为52.5岁。从卵巢癌诊断到CNS转移诊断的中位间隔时间为14.5个月。7例患者在CNS复发前接受了顺铂治疗。7例患者在发生CNS转移前接受了二次探查手术；其中3例结果为阴性。8例患者在CNS复发时存在腹膜外扩散至其他部位的证据。临床表现包括运动无力、癫痫发作、头痛、意识模糊和言语障碍。所有病变在计算机断层扫描（CT）上均有强化，且位于大脑半球。9例患者有单个病变，其中5例接受了病变的手术切除，组织学证实为原发部位的转移。单纯接受放疗的患者中位生存期为2个月，接受手术和放疗的患者中位生存期为17个月。整个系列的中位生存期为3个月。存在多个脑转移或身体其他部位有腹膜外扩散的证据与生存呈负相关。卵巢癌脑转移患者的预后似乎较差。然而，通过常规CT扫描早期诊断，随后进行手术切除和放疗，可能会改善部分患者的总体生存。
