PMC7755878_01
Timeline of different treatments and disease status.
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Figure 1. For her past history, she underwent primary debulking surgery in November 2017 in another hospital.
MRI baseline of brain metastases. (A) Axial T2-weighted fluid-attenuated inversion recovery (FLAIR) shows circular high signal (black arrow) of the left anterior border of cerebellum. (B) Axial T2-weighted FLAIR shows patchy edema of bilateral frontal and left occipital lobes (white arrows) and right frontal lobes signals such as nodules (black arrow). (C) Axial gadolinium-enhanced T1-weighted MRI shows cerebellar left front ring mass with peripheral rim enhancement surrounding a low-signal-intensity area of central necrosis (white arrow). (D) Axial gadolinium-enhanced T1-weighted MRI shows bilateral frontal lobe and left occipital small ring enhancement (white arrows).
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CA125 was 30.41 U/mL. CT head scan demonstrated multiple lesions within bilateral frontal lobe, parietal lobe and right cerebellum as well as MRI-detected multiple BMs at the same locations (Figure 2).
PET-CT showed recurrence and metastases of ovarian cancer. Increased 18F-FDG uptake was shown in brain (A), right para-aortic lymph nodes (B), and lesser sac (C).
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Although we did not have a biopsy of intracranial lesions to confirm metastasis over primary carcinoma, the performance of 18F-FDG PET/CT consistent with metastatic lesions of lesser sac and lymph nodes was a reliable basis for diagnosis (Figure 3).
Head MRI after whole-brain irradiation and chemotherapy. (A) Axial T2-weighted FLAIR shows small spot high signal (black arrow) of the left anterior border of cerebellum. (B) Axial T2-weighted FLAIR shows patchy edema of right frontal lobes (white arrow). (C) Axial gadolinium-enhanced T1-weighted image shows cerebellar left front small spot enhancement (white arrow). (D) Axial gadolinium-enhanced T1-weighted image shows right frontal lobe small spot enhancement (white arrow).
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A remission of brain metastases was then detected by head MRI after WBRT and chemotherapy (Figure 4), and her CA125 reduced from 46.8 IU/mL to 23.7 IU/mL.
Head MRI after niraparib maintenance therapy. (A) after three months of niraparib. (B) After six months of niraparib. (C) After nine months of niraparib. Axial T2-weighted FLAIR shows reduction of small spot high signal of the left anterior border of cerebellum (black arrow), Axial gadolinium-enhanced T1-weighted MRI shows vanish of cerebellar left front tiny dot enhancement (white arrow) and of the right frontal lobe tiny dot enhancement.
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August 2019, the dosage has been increased to 200 mg once daily and the patient is currently on this treatment regimen. After nine months of niraparib administration, BM almost disappeared on the head MRI (Figure 5).