Investigation of prognostic factors and evaluation of treatment modalities in gynecological origin malignancies with brain metastasis

Objective: Development of brain metastases is a very important clinical process that is rarely seen in malignancies of gynecological origin, but can cause serious complications or mortality in patients. In recent years, it has been observed that the frequency of brain metastases has increased gradually with the prolongation of survival times due to gynecological malignancy and the development of diagnostic methods. In this study, it was planned to reveal the clinicopathological features of brain metastases arising from gynecological malignancies and to analyze the effect of these features on prognosis. Material and Methods: 48 patients with brain metastases who were followed up for gynecological cancer in the Baskent University department of Gynecologic Oncology between 2008 and 2021 were evaluated retrospectively. Demographic, clinical and pathological characteristics of the patients and the distribution of treatments according to gynecological cancers were shown since the time of primary diagnosis. Median survival times after the diagnosis of brain metastasis were evaluated statistically. Prognostic factors affecting the process of brain metastasis and survival after diagnosis were statistically analyzed. Results: Median survival after diagnosis of brain metastasis was 8 months. According to gynecological origin, it was 12 months in ovarian cancer, 4 months in endometrial cancer, 8 months in cervical cancer, 3 months in vulvar cancer and 4 months in uterine sarcomas. In the univariate analysis, it was seen that the number of the lesion, localization, extracranial metastasis status and the treatment modality applied were associated with survival after brain metastasis, while the lesion localization and treatment modality were the independent variables affecting the prognosis in the multivariate analysis. Number of lesions with the patients having ovarian cancer were not found significant statistically. It was observed that the prognosis after brain metastasis in patients with ovarian cancer with platinum sensitivity was better than in resistant patients. It is predicted that the survival time will increase with the early diagnosis of the cases, the correct evaluation of the prognostic factors and the appropriate treatment. When the results of this study and the literature are evaluated, it is thought that there is a need for more multicenter studies involving more patients. Key Words: Gynecologic cancer, Brain metastases, prognosis, radiotherapy