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FIGURE 18.3 MRI with gadolinium shows a large deep temporal-occipital brain metastases in a patient with a history of ovarian carcinoma (A). The patient underwent five courses of carboplatin (intra-arterial), cyclophosphamide (intravenous), and etoposide phosphate (intravenous) with BBBD. MRI with gadolinium shows a dramatic response after BBBD chemotherapy (B). Radiosurgery was then given to the small residual enhancing lesion (arrow).

FIGURE 18.3 MRI with gadolinium shows a large deep temporal-occipital brain metastases in a patient with a history of ovarian carcinoma (A). The patient underwent five courses of carboplatin (intra-arterial), cyclophosphamide (intravenous), and etoposide phosphate (intravenous) with BBBD. MRI with gadolinium shows a dramatic response after BBBD chemotherapy (B). Radiosurgery was then given to the small residual enhancing lesion (arrow).

metastatic CNS lesion (see Figs. 18.3A,B). The patient refused brain surgery and was treated with carboplatin (intra-arterial), cyclophosphamide (intravenous), and etoposide phosphate (intravenous) with BBBD. MRI showed dramatic response to the chemotherapy. Radiosurgery was then given to the enhancing lesion. Following radiosurgery, the patient was in remission for 41 months and maintained full functional status (KPS = 90).

The overall survival from diagnosis of the gynecologic cancer ranged from 25 to 65 months, with an average of 47 months (see Table 18.1). The mean survival from the diagnosis of CNS metastases was 26 months. These results are among the best reported survivals for CNS metastases of ovarian cancer. Three of the five patients had KPS of 80 or above prior to starting the treatment; these three had the longest survivals and sustained a KPS of 80 or above during intra-arterial or BBBD treatment. These findings suggest that further investigation of the role of BBBD-enhanced chemotherapy in CNS metastases is warranted.

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