Prognostic factors for survival and intracerebral control after irradiation for brain metastases from gynecological cancer

Objective: The most appropriate treatment for the individual patient with brain metastases from gynecological cancer is unclear. Most of these patients receive whole-brain radiotherapy (WBRT) alone. Prognostic factors predicting the outcomes of these patients may guide the physician to select the appropriate treatment regimen for the individual patient. Methods: The data of 42 patients with brain metastases from gynecological cancer treated with WBRT alone were retrospectively analyzed. Six potential prognostic factors were evaluated for survival and intracerebral control including WBRT regimen, age, Karnofsky performance score (KPS), primary tumor type, number of brain metastases, and extracranial metastases at the time of WBRT. Results: On univariate analysis, improved survival was associated with KPS ≥ 70 (P < 0.001), < 4 brain metastases (P = 0.033), and lack of extracranial metastases (P = 0.008). On multivariate analysis, KPS maintained significance (P < 0.001). On univariate analysis, improved intracerebral control was associated with KPS ≥ 70 (P = 0.003). KPS was also significant in the multivariate analysis (P = 0.007). Conclusions: KPS was the most important predictor for both survival and intracerebral control. For patients with a KPS < 70, a short-course of WBRT appears appropriate. For patients with a KPS ≥ 70, more aggressive treatment regimens including longer courses of WBRT, resection or radiosurgery should be seriously considered.