Prognostic Factors Affecting Survival in Patients with Brain Metastases from Gynecologic Cancer

Brain metastasis (BM) from gynecologic carcinomas (GCs) is a rare but increasing phenomenon, with the rising life expectancy of patients with GCs. This study aimed to review a series of patients with BM from GCs and describe their clinical features, treatment outcomes, and prognostic factors. In this retrospective cohort study, 49 GC patients with BM were examined, and factors associated with survival were analyzed. The primary carcinomas were ovarian cancer in 27 (55.1%) patients, uterine cancer in 14 (28.6%), and cervical cancer in 8 (16.3%). For the total cohort, the median time from the initial diagnosis to BM was 24.0 (1.0-148.0) months; for ovarian, uterine, and cervical cancer, it was 32.0 (1.0-148.0), 13.0 (1.0-74.0), and 6.0 (2.0-44.0) months, p= 0.001; for stage 1-2, stage 3 and stage 4 tumors, it was 36.0 (13.0-94.0), 24.0 (1.0-148.0), and 13 (1.0-26.0) months, respectively, p= 0.006. The median survival from BM was 7.0 (95% Cl: 3.68-10.32) months in the entire cohort. Three or more BMs (HR= 5.79, 95% CI:1.27-26.36; p=0.023), extracranial disease progression (HR= 4.38, 95% CI: 1.22-15.72; p= 0.024), and whole-brain radiotherapy (WBRT) (HR= 5.80, 95% CI: 1.88-17.92; p= 0.002) were associated with worse survival. Three or more BMs, extracranial disease progression, and WBRT compared to stereotactic radiotherapy (SRT) adversely affect the prognosis of GC patients with BMs. Additionally, GC type and disease stage at diagnosis affect the time to BMs. Keywords: Gynecological cancer, Brain metastasis, Uterine, Ovarian, Cervical cancer