Central nervous system metastasis in gynecologic cancer: symptom management, prognosis and palliative management strategies.
Gynecol Oncol
; 136(3): 472-7, 2015 Mar.
Article
in En
| MEDLINE
| ID: mdl-25752572
ABSTRACT
INTRODUCTION:
CNS metastasis (CNSmet) with gynecologic malignancy (GM) is associated with poor prognosis and symptom burden. Two prognostic indices, the recursive partitioning analysis (RPA) and graded prognostic assessment (GPA), used in other solid tumors to guide intervention options were evaluated among GM patients.METHODS:
Retrospective chart review was performed to identify patients with primary GM diagnosed with CNSmet from 2005-2014. RPA and GPA were applied and evaluated for goodness of fit. Long-term survivors (LTS) were those with survival time from CNSmet ≥9 months.RESULTS:
35 patients were identified with median age of 62 years (range, 41-78). The majority had ovarian cancer (54%). Median survival was 4.5 months (0.1-25.9), and median time from initial diagnosis was 2.6 years (0-19.6). Presenting symptoms varied but headache (57%) and altered mental status (23%) were most common. 37% had a solitary CNS lesion, 31% had 2-8, and 31% >8. 57% were treated with WBRT, 14% with stereotactic radiosurgery (SRS), and 20% with combinations of treatments, and 2 elected for hospice. 27% (9/33) of the patients were LTS. The GPA was not significantly associated with patient outcome (p=0.46). The RPA predicted time to death (p=.0010).CONCLUSION:
Prognostic indices used to guide therapeutic interventions perform poorly in GM. Detection and aggressive symptom management are critical in maintaining QOL. Multidisciplinary consultation is critical to optimize outcomes and symptom control.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Palliative Care
/
Brain Neoplasms
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Genital Neoplasms, Female
Type of study:
Diagnostic_studies
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Evaluation_studies
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Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adult
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Aged
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Female
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Humans
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Middle aged
Language:
En
Journal:
Gynecol Oncol
Year:
2015
Document type:
Article