Email updates

Keep up to date with the latest news and content from BMC Cancer and BioMed Central.

Open Access Case report

A late, solitary brain metastasis of epithelial ovarian carcinoma

Raffaele Longo1*, Christian Platini1, Nada Eid1, Clémence Elias-Matta1, Thaar Buda2, Denis 'Nguyen3 and Philippe Quétin3

Author Affiliations

1 Division of Medical Oncology, CHR Metz-Thionville, 1 Allée du Château, 57085 Ars-Laquenexy, France

2 Division of Radiology, CHR Metz-Thionville, 1 Allée du Château, 57085 Ars-Laquenexy, France

3 Division of Radiotherapy, CHR Metz-Thionville, 1 Allée du Château, 57085 Ars-Laquenexy, France

For all author emails, please log on.

BMC Cancer 2014, 14:543  doi:10.1186/1471-2407-14-543

Published: 28 July 2014

Abstract

Background

Brain metastasis from epithelial ovarian cancer (EOC) is very rare with a reported incidence of less than 2%. It is usually associated with a poor prognosis that is related to several factors, the most important including: single vs multiple lesions, performance status, platinum-sensitive disease, tumor grade, extracranial disease, and multimodal approach treatment. At the time of diagnosis, an extracranial disease is found in over half of patients. The most common histology is the serous type. The median time from primary diagnosis to development of cerebral lesions is directly correlated to initial tumor grade and stage. Several therapeutic approaches can be proposed, including best supportive care +/- corticosteroids, surgery, radiotherapy and chemotherapy. A multimodal therapy approach may achieve an improved outcome and should therefore be utilized whenever applicable.

Case presentation

We present the case of a patient with a solitary brain metastasis which appeared 11 years after a locally advanced and aggressive EOC (FIGO stage III C) and which totally regressed after surgery and adjuvant chemotherapy. Clinically, she showed progressive headaches, decreased visual acuity, balance and memory disorders associated with a confusional state. Brain CT scan and MRI documented a solitary, necrotic lesion in the left central parietal region with an important cerebral surrounding edema and initial cranial herniation. No other extracranial metastases were observed at the PET scan. Laboratory tests were in the normal range and CA 125 was moderatly increased at 81 UI/ml. The patient underwent surgical removal of tumor lesion, post-surgical whole-brain radiotherapy (WBRT) and systemic chemotherapy with carboplatin alone for six cycles. At a follow-up of 13 months, she is alive, in good clinical condition and tumor progression free.

Conclusion

The peculiarity of this case relies on the isolated brain relapse of a BRCA-1/BRCA-2 non-mutated EOC, which is uncommon and rare, and to the very long time, of 11 years, from diagnosis of primary cancer and development of brain metastasis. A multimodal, aggressive approach of this isolated brain metastasis led to a complete and prolonged tumor control.

Keywords:
Ovarian cancer; Brain metastases