Brain metastases from cervical cancer reduce longevity independent of overall tumor burden

Ariel Takayanagi; T J Florence; Omid R Hariri; Abigail Armstrong; Pouria Yazdian; Andrew Sumida; Syed A Quadri; Joshua Cohen; Omid S Tehrani

doi:10.25259/SNI_37_2019

Brain metastases from cervical cancer reduce longevity independent of overall tumor burden

Surg Neurol Int. 2019 Sep 13:10:176. doi: 10.25259/SNI_37_2019. eCollection 2019.

Authors

Ariel Takayanagi¹, T J Florence^{2

3}, Omid R Hariri^{4

5}, Abigail Armstrong⁶, Pouria Yazdian⁷, Andrew Sumida⁸, Syed A Quadri⁹, Joshua Cohen⁵, Omid S Tehrani¹⁰

Affiliations

¹ Department of Neurosurgery, Riverside University Health Systems, Moreno Valley, USA.
² Department of Neurosurgery, Columbia University College of Physicians and Surgeons, New York, USA.
³ Department of Neurosurgery, University of California Los Angeles, Los Angeles, USA.
⁴ Department of Neurosurgery, Stanford University School of Medicine, Stanford, USA.
⁵ Department of Neurological Surgery, Kaiser Permanente Orange County, Anaheim, USA.
⁶ Department of Obstetrics and Gynecology, University of California Los Angeles Medical Center, Santa Monica, USA.
⁷ Department of Medicine, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Yazd Province, Iran.
⁸ Department of Internal Medicine, Center for Medical Education and Research, University of California San Francisco, Fresno, USA.
⁹ Department of Neurology, Harvard Medical School, Boston, MA, USA.
¹⁰ Department of Oncology, Stanford Cancer Center, Stanford University School of Medicine, Stanford, CA, USA.

Abstract

Background: Isolated brain metastasis (IBM) from cervical cancer is a very rare encounter in neurosurgery. We sought to understand how patients with isolated brain metastases differ from those with metastases in the setting of widespread disease.

Methods: A systematic review was completed using PubMed and the Cochrane Library. Patients with isolated brain metastases (IBM) and non-isolated brain metastases (NIBM, or brain metastases in the setting of disseminated disease), were compared. Two-sided statistical tests were used to determine significance. Survival function was carried out using the Kaplan-Meier method.

Results: A total of 89 patients, 25 with IBM and 64 with NIBM, were identified. The time interval between initial diagnosis of cervical cancer and diagnosis of brain lesion was significantly shorter in the IBM group (median 7.5 vs. 20.05 months, and IBM vs. NIBM, respectively; P = 0.006). Overall survival from initial diagnosis of cervical cancer was significantly shorter for the IBM group versus the NIBM group (7.63 vs. 26.3 months, respectively; P = 0.0005). Data demonstrate a 3.4-fold reduction of median life expectancy to 7.63 months. Survival after diagnosis of brain metastases did not differ between groups (median, IBM 7 months vs. NIBM 4 months, P = 0.08).

Conclusion: Taken together, our data suggest that for cervical cancer patients with brain metastasis intracranial metastasis itself (and not overall tumor burden) represent a sentinel event in limiting longevity. While the present study is underpowered to compare treatment options directly, further work should be focused on determining the optimal treatment for these patients.

Keywords: Brain; Cancer; Cervical; Cervix; Isolated; Metastases; Non-isolated; Survival; Uterine; Uterus.