Brain Metastases from Ovarian Cancer: Current Evidence in Diagnosis, Treatment, and Prognosis

Abstract

With this review, we provide the state of the art concerning brain metastases (BMs) from ovarian cancer (OC), a rare condition. Clinical, pathological, and molecular features, treatment options, and future perspectives are comprehensively discussed. Overall, a diagnosis of high-grade serous OC and an advanced disease stage are common features among patients who develop brain metastases. BRCA1 and BRCA2 gene mutations, as well as the expression of androgen receptors in the primary tumor, are emerging risk and prognostic factors which could allow one to identify categories of patients at greater risk of BMs, who could benefit from a tailored follow-up. Based on present data, a multidisciplinary approach combining surgery, radiotherapy, and chemotherapy seem to be the best approach for patients with good performance status, although the median overall survival (<1 year) remains largely disappointing. Hopefully, novel therapeutic avenues are being explored, like PARP inhibitors and immunotherapy, based on our improved knowledge regarding tumor biology, but further investigation is warranted.

Keywords: BRCA; brain metastases; diagnosis; management; ovarian cancer; pathology; radiotherapy; surgery; treatment.

Figure 1

Histological images (original magnification: 20X) of a brain metastasis from ovarian cancer. Hematoxylin-eosin stain (A) shows a papillary carcinoma with hyperchromic nuclei and prominent nucleoli, surrounded by GFAP-positive brain parenchyma (B). Immunohistochemistry showed a consistent profile: positive stainings for CA-125 (C), Estrogen Receptors (D), Wilms Tumor-1 (E) and PAX-8 (F) and, focally, for Androgen Receptors (G).