Survival outcomes and patterns of care in ovarian carcinoma patients with brain metastases: A real-world analysis.

Abstract

e14010 Background: Brain metastases (BM) from ovarian cancer (OC) are rare, with an estimated incidence of 0.5-2.4%. The rarity of these cases presents significant challenges in determining optimal treatment strategies. This study evaluates survival outcomes and treatment approaches for BM patients from OC using data from the National Cancer Database (NCDB). Methods: Patients diagnosed with BM from OC between 2010-2022 were identified from NCDB. Baseline characteristics were summarized as percentages. Median overall survival (mOS) was estimated using the Kaplan-Meier method. Demographic variables (age, race, insurance, income), comorbidity scores, and treatment modalities were analyzed. Survival differences were assessed using Cox proportional hazard modeling. Results: Of the 61,759 patients with metastatic OC, 405 (0.65%) were diagnosed with BM. In this analysis, with a median follow-up of 19.7 months (range: 0.53–143.9), most were ≥55 years-old (69.9%), White (88.6%), had a Charlson-Deyo score of 0 (71.3%), and resided in urban areas (80.5%). Insurance was predominantly government-funded (53.1%) or private (42.75%), with 50.2% reporting an annual income of $46,277–$74,062. Treatment approaches included systemic therapy (ST) only (40%), ST combined with whole brain radiotherapy (WBRT, 27.8%), ST combined with stereotactic radiosurgery (SRS17.9%), WBRT alone (10.3%), and SRS alone (3.8%). The mOS for all patients was 10.1 months (95% CI: 7.6–13.4). The mOS was significantly longer for ST+SRS patients (18.6 months) compared to ST only (9.2 months) and WBRT alone (4.2 months) (p = 0.01). 6-month survival rates were 77.0% for ST+SRS, 61.9% for ST only, and 33.4% for WBRT alone. Survival rates at 12-month were 66.8%, 46.4%, and 23.8%, respectively. Younger age ( < 55 years) was associated with improved survival (HR = 0.5, 95% CI: 0.25–0.99, p = 0.048). Patients who identified as neither White nor Black (other race) had significantly worse outcomes (HR = 49.7, p = 0.002). Conclusions: Patients with BM from OC have decreased survival, with ST+SRS associated with the best prognosis. Future efforts should focus on expanding healthcare coverage, increasing access to specialized oncology services, and developing evidence-based treatment guidelines for this rare population. Prospective studies are needed to explore the role of ST+SRS based on the site and number of lesions. Survival outcomes by treatment modality. ST WBRT SRS ST + WBRT ST + SRS Survival Rate%, (95% CI)6-Month1-Year2-Year 61.9(51.5–70.7)46.4(36.3–56.0)30.5(21.6–39.9) 33.4(15.9–51.9)23.8(9.1–42.4)14.3(3.7–31.8) 55.6(20.4–80.45)11.1(0.6–38.8)11.1(0.6–38.8) 67.6(55.4–77.2)46.5(34.6–57.5)29.3(19.2–40.2) 77.0(60.5–87.3)66.8(49.7–79.2)38.1(23.1–52.9) mOS (months) (95% CI) 9.2(6.2–15.9) 4.2(1.7–8.2) 9.7(1.0–11.7) 11.1(6.6–13.4) 18.6(9.9–26.7)