Brain metastases from ovarian cancer: neuroradiological profile and survival overview of neurosurgical cases

Objectives: This study aims to identify the radiological features of brain metastases (BM) from ovarian cancer (OC) and correlate them to clinical and genetic data. Additionally, the impact of neurosurgery on patient survival is evaluated. Materials and methods: A single-center, retrospective, observational study was conducted, involving 106 patients with BM from OC. Neuroradiological imaging was available for 66 patients. The data collected were analyzed using linear correlation and ANOVA tests and multivariable Cox proportional hazards regression for survival analysis. Survival was assessed using Kaplan-Meier curves. Results: The most prevalent histological subtypes were high grade serous (90%) OC. The main neuroradiological feature was necrosis (79%). BM were multiple in 56% of cases, with a prevalent distribution in the cerebral hemispheres (80.30%). Additional neuroradiological features included a volume greater than 1000 mm³ (71%), hemosiderin deposits on SWI (67%), abundant perilesional edema (53%), and the presence of hemorrhage (15%). The mean apparent diffusion coefficient (ADC) value of BM was 781.5 × 10^-6 mm²/s, while relative cerebral volume (rCBV) was lower in patients with posterior fossa BM (p = 0.049). Neurological symptoms were present in 39% of cases, and a linear correlation was identified between neurological symptoms and both tumor volume (p = 0.0008) and the presence of necrosis (p = 0.04). The BRCAm was associated to longer survival (p = 0.04) and was associated with less perilesional edema (OR = 0.145, CI: 0.027–0.776). The Kaplan-Meier analysis showed an overall survival (OS) of 46 months in BRCAwt patients who underwent neurosurgery, vs. 37 months in patients who did not (p = 0.03). Cox analysis identified BRCAm status, performance status, post-BM chemotherapy, and CNS-only disease as independent predictors of better survival; surgery was not significant. Conclusion: The current study supports the established protective value of the BRCA mutation and suggests that neurosurgical treatment of BM after a comprehensive evaluation may improve survival, even in BRCAwt patients. Clinical relevance statement: The critical need for early detection of BMs that are appropriate for surgical intervention is highlighted, as timely action can greatly improve patient outcomes.