Managing Brain Leisons in Gynecological Cancers: A Case Series

Brain metastasis in recurrent setting is a rare phenomenon in gynecological cancers. Even rarer is the occurrence of second intracranial primary. All these women generally will present with subtle neurological symptoms. However due to its rarity and non-specificity of symptoms, these often tend to get missed. Here we present a case series of six women of known gynecological cancers who presented to our department with brain space occupying lesions (SOLs). Five among these were primary ovarian cancers who had recurred with brain metastasis. The sixth one was a case of endometrial cancer treated in the past for recurrence and now presenting with a second primary. MRI brain was used to confirm diagnosis in all of them. Two were inoperable disease due to diffused parenchymal brain metastasis. They received palliative care and died subsequently. Four were initially managed with surgical resection with uneventful postoperative outcome. This was followed by adjuvant treatment in the form of whole brain radiotherapy (WBRT) with or without chemotherapy. Three of them successfully completed their adjuvant treatment and kept on follow-up whereas the fourth progressed on treatment. Their long-term outcomes are yet to be seen. Selected cases with brain metastasis merits aggressive approach with surgical removal of tumor followed by adjuvant treatment.