Gamma Knife radiosurgery for gynecologic metastases to the brain: Analysis of pathology, survival, and tumor control.

Autor: Wei Z; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America., Luy DD; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America., Tang LW; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America., Deng H; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America., Jose S; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America., Scanlon S; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America., Niranjan A; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America., Lunsford LD; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America. Electronic address: lunsld@upmc.edu.
Jazyk: angličtina
Zdroj: Gynecologic oncology [Gynecol Oncol] 2023 May; Vol. 172, pp. 21-28. Date of Electronic Publication: 2023 Mar 14.
DOI: 10.1016/j.ygyno.2023.03.006
Abstrakt: Objective: This study aims to evaluate the efficacy of stereotactic radiosurgery (SRS) in improving health outcomes of patients with gynecologic brain metastases.
Methods: Patients with gynecologic metastases treated with SRS from 2008 to 2020 were retrospectively reviewed. The median age at SRS was 63 years old (cervical 45.5, endometrial 65.5, ovarian 61). The median number of tumors was 3 (range 1-27), and cumulative tumor volume was 2.33 cc (range 0.03-45.63). Median margin dose prescribed was 16 Gy (range 14 Gy - 20 Gy). The median 12 Gy volume was 7.30 cc (range 0.21-74.14 cc). Outcome variables included overall survival (OS) after SRS, local tumor control (LTC), distant tumor control, and adverse radiation effect (ARE).
Results: Fifty patients (4 cervical, 25 endometrial, and 21 ovarian cancer) were identified. The OS at 6 and 12 months after SRS was 48%, and 44%, respectively. Eight patients (16%) died from CNS disease progression. The number of brain metastases (p = 0.011) and the Karnofsky Performance Scale (KPS) ≥ 70 (p = 0.020) were significant predictors of OS. LTC rate at 6 and 12 months were 92%, and 87%, respectively. Margin dose ≥16Gy correlated with significantly better local tumor control (p = 0.0001) without increased risk of ARE (p = 0.055). The risk of developing new metastases at 6 and 12 months were 12% and 24% respectively. SRS-induced ARE events occurred in 7 patients.
Conclusion: Intracranial metastases from gynecologic malignancy can be effectively treated using SRS with low risk of neurotoxicity. Margin dose ≥16Gy can provide significantly better tumor control. Repeat SRS can be utilized to treat new metastases while avoiding the potential cognitive symptoms associated with WBRT.
Competing Interests: Declaration of Competing Interest Dr. L. Dade Lunsford is an AB Elekta stockholder. All other authors have no competing interests to declare that are relevant to the content of this article.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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