A 63-Month Journey of Surgery, Chemotherapy, and Targeted Maintenance

A 39-year-old woman was first diagnosed with Stage IIIC (FIGO 2014) high-grade serous carcinoma (HGSC) ovarian cancer—testing negative for germline BRCA1/2 mutations. She underwent primary debulking surgery, successfully achieving complete resection of the tumors. Adjuvant treatment followed with six cycles of TC chemotherapy (paclitaxel and carboplatin), which helped manage any microscopic residual disease.

At 24 months post-diagnosis, routine imaging discovered a recurrence that included multiple brain metastases and new lymph node involvement. Surgeons opted for gamma knife (γ-knife) irradiation to precisely target the brain lesions while minimizing surrounding tissue damage. Afterward, the patient received an additional six cycles of TC therapy. Recognizing the possibility of further recurrence, her medical team initiated maintenance therapy with olaparib—a PARP inhibitor typically more effective in BRCA-mutated cases, but considered here in the face of an aggressive disease.

Remarkably, as of August 2023—63 months from the time of her initial diagnosis, and 57 months into olaparib maintenance—the patient remains in complete remission. This extended survival, including 63 months beyond the onset of brain metastases, underscores the potential power of combining surgical expertise, targeted radiotherapy, consistent chemotherapy, and ongoing maintenance treatment in managing advanced ovarian cancer, even in the absence of a BRCA mutation.