Introduction/Background Brain metastasis (BM), rare in ovarian cancer (OC), is associated with a median overall survival (OS) typically < 1 year. Treatment options include whole brain radiotherapy, stereotactic radiosurgery (SRS) or palliative care. The literature on outcomes following SRS in OC is limited. We report our institutional experience with SRS treatment for BM in an era of targeted therapies.

Methodology OC patients treated with SRS at The Royal Marsden Foundation Trust from 2016–2022 were included. We retrospectively evaluated clinical characteristics, radiation dose and fractionation and survival.

Results 21 OC patients underwent SRS for BM [median age 64 years (range 28–81), 71% FIGO stage III and 29% stage IV at diagnosis, median systemic treatment lines 2 (0–6), 2/21 prior PARP inhibitor]. 18.7% (3/16 patients tested) harboured a BRCA1/2 mutation. Median time from diagnosis to BM was 34 months (range 0–87.9). Neurological symptoms were present in 62% (13/21) of patients, however 19% (4/21) were asymptomatic, identified during screening for clinical trials. At time of BM diagnosis, five patients had BM only (24%) with no evidence of extra-cranial disease. Solitary BM was diagnosed in 38% (8/21) whereas multiple BM (range 2–7) were evident in 62% (13/22). Median treatment dose was 16–24 Gy/1 fraction and 21–24Gy/3 fractions. In 29% (6/21), platinum-based chemotherapy to treat extra-cranial disease was administered within 8 weeks after SRS. Median PFS from BM diagnosis to brain progression was 9.2 months (2.5–50.8), and median PFS from BM to systemic disease progression was 5 months (0–25.3 months). Median OS from SRS treatment was 16 months (1.1–49.7 months). Three patients (14.3%, all BRCA-mutated) received PARPi subsequently to SRS. Among this group mOS was 27 months (9–38).

Conclusion In this retrospective series, overall survival following SRS for BM diagnosis exceeds 1 year. Post SRS, systemic treatment should be considered for selected patients.