816 l SEPTEMBER JOGC SEPTEMBRE 2013 GYNAECOLOGY Key Words: Ovarian cancer, brain metastases, gamma-knife radiotherapy, treatment modalities Competing Interests: None declared Received on January 27, 2013 Accepted on June 19, 2013 Brain Metastases in Women With Epithelial Ovarian Cancer: Multimodal Treatment Including Surgery or Gamma-Knife Radiation Is Associated With Prolonged Survival Xiaoyu Niu, MD, 1 Anupama Rajanbabu, MD, MRCOG, 2 Megan Delisle, DEC, 3 Feng Peng, MD, PhD, 4 Dehannathuparambil K. Vijaykumar, MS, MCh, 2 Keechilattu Pavithran, MD, DM, 5 Yukuan Feng, MD, 1 Susie Lau, MD, MSc, FRCSC, 3 Walter H. Gotlieb, MD, PhD, 3 Joshua Z. Press, MD, MSc, FRCSC 3 1 Obstetric and Gynecologic Department, Sichuan University Huaxi Second Hospital, Sichuan Province, China 2 Surgical and Gynecologic Oncology, Amrita Vishwavidyapeetham, Kochi, Kerala, India 3 Division of Gynecologic Oncology, Jewish General Hospital/Segal Cancer Centre/McGill University, Montreal QC 4 Oncology Department, Sichuan University Huaxi Hospital, Sichuan Province, China 5 Department of Medical Oncology, Amrita Institute of Medical Sciences, Amrita Vishwavidyapeetham, Kochi, Kerala, India Abstract Objective: To explore the impact of treatment modality on survival in patients with brain metastases from epithelial ovarian cancer Methods: We conducted a retrospective review of cases of ovarian cancer with brain metastases treated at institutions in three countries (Canada, China, and India) and conducted a search for studies regarding brain metastases in ovarian cancer reporting survival related to treatment modality Survival was analyzed according to treatment regimens involving (1) some form of surgical excision or gamma-knife radiation with or without other modalities, (2) other modalities without surgery or gamma-knife radiation, or (3) palliation only Results: Twelve patients (mean age 56 years) with detailed treatment/outcome data were included; five were from China, four from Canada, and three from India Median time from diagnosis of ovarian cancer to brain metastasis was 19 months (range 10 to 37 months), and overall median survival time from diagnosis of ovarian cancer was 38 months (13 to 82 months) Median survival time from diagnosis of brain metastasis was 17 months (1 to 45 months) Among patients who had multimodal treatment including gamma-knife radiotherapy or surgical excision, the median survival time after the identification of brain metastasis was 256 months, compared with 60 months in patients whose treatment did not include this type of focused localized modality (P = 0006) Analysis of 20 studies also indicated that use of gamma-knife radiotherapy and excisional surgery in multi-modal treatment resulted in improved median survival interval (25 months vs 60 months, P < 0001) Conclusion: In the subset of patients with brain metastases from ovarian cancer, prolonged survival may result from use of multidisciplinary therapy, particularly if metastases are amenable to localized treatments such as gamma-knife radiotherapy and surgical excision Résumé Objectif : Explorer les effets de la modalité de traitement sur la survie chez les patientes qui présentent des métastases cérébrales attribuables au cancer épithélial de l’ovaire Méthodes : Nous avons mené une analyse rétrospective des cas de cancer de l’ovaire donnant lieu à des métastases cérébrales qui ont été traités dans des établissements se situant dans trois pays (Canada, Chine et Inde); de plus, nous avons mené une recherche qui visait les études ayant traité des métastases cérébrales associées au cancer de l’ovaire qui faisaient mention des taux de survie liés aux modalités de traitement La survie a été analysée en fonction de schémas de traitement mettant en jeu (1) une forme quelconque d’excision chirurgicale ou de radiochirurgie par scalpel gamma avec ou sans autres modalités, (2) d’autres modalités sans chirurgie ni radiochirurgie par scalpel gamma ou (3) des modalités palliatives seulement Résultats : Douze patientes (âge moyen : 56 ans) comptant des données détaillées en ce qui concerne le traitement / les issues ont été admises à l’étude; cinq d’entre elles étaient de la Chine, quatre du Canada et trois de l’Inde Le délai médian entre le diagnostic de cancer de l’ovaire et l’apparition de métastases cérébrales était de 19 mois (plage de 10 à 37 mois), et la durée