Survival prediction in patients with gynecological cancer irradiated for brain metastases

Abstract

Background and purpose: This large population-based, retrospective, single-center study aimed to identify predictive factors in patients with brain metastases (BM) from gynecological cancers. Material and methods: 144 patients with BM from gynecological cancer treated with radiotherapy were identified. Primary cancer diagnosis, age, performance status, number of BM, presence of extracranial disease and type of BM treatment were assessed. Overall survival (OS) was calculated using the Kaplan-Meier method and Cox proportional hazards regression model was used for multivariable analysis. A prognostic index was developed based on scores from independent predictors of OS. Results: Median OS for the entire study population was 6.2 months. Forty percent of patients died within 3 months after start of radiotherapy. Primary cancer with the origin in cervix or vulva (p=0.001), ECOG 3-4 (p<0.001) and the presence of extracranial disease (p=0.001) were associated with significantly shorter OS. The developed prognostic index based on these factors, categorized patients into three risk groups with a median OS of 13.5, 4.0 and 2.4 months for the good, intermediate and poor prognosis group, respectively. Conclusion: Patients with BM from gynecological cancers carry a poor prognosis. We identified predictive factors for survival and developed a scoring tool to help differentiate patients with better or worse prognosis. Patients in the high-risk group have a particular poor prognosis, and omission of radiotherapy should be considered.