Abstract
Objective: Gamma Knife® (GK) (Elekta Instruments, Stockholm, Sweden) radiosurgery is well established for treatment of brain metastases. There are limited data on patients treated with GK from gynecological cancers. The authors sought to determine the effectiveness of the GK in patients with brain metastases from gynecological cancers.Methods: An IRB-approved database was queried for patients with gynecologic cancers treated with GK between June 1996 and May 2016. Imaging studies were reviewed post-SRS (stereotactic radiosurgery) to evaluate local control (LC) and distant brain control (DC). Overall survival (OS), local control, and distant brain control were calculated using the Kaplan-Meier (KM) method and log-rank test. Results: Thirty-three patients underwent SRS for 73 separate cranial lesions. The median age was 58.5 years, and 17 (52%) also had extracranial metastases. Ten (30%) patients had previously received whole brain radiotherapy (WBRT), and 11 (33%) underwent concurrent WBRT. The median tumor volume was 0.96 cm3. Median radiographic follow-up was 11 months. At the time of treatment, 39% of patients were categorized as recursive partitioning analysis (RPA) Class I, 55% as RPA Class II, and 6% as RPA Class III. The local failure rate was 8%. Five patients (15%) developed new brain lesions outside the radiation field with a median progression-free survival (PFS) of seven (range: 3-9) months. Median OS was 15 months from GK treatment. One-year OS was 72.9% from GK treatment. Primary cancer histology was a significant predictor of OS, favoring ovarian and endometrial cancer (p = 0.03).Conclusions: Gamma Knife stereotactic radiosurgery for gynecologic brain metastases leads to excellent control rates of treated lesions. Primary histology may have a significant impact on OS following GK, with improved survival seen with ovarian and cervical cancer following Gamma Knife radiosurgery (p = 0.03).
Highlights
In the United States, 105,890 cases of gynecologic malignancies will be diagnosed, and 30,890 patients will die in 2016 [1]
At the time of treatment, 39% of patients were categorized as recursive partitioning analysis (RPA) Class I, 55% as RPA Class II, and 6% as RPA Class III
Gamma Knife stereotactic radiosurgery for gynecologic brain metastases leads to excellent control rates of treated lesions
Summary
In the United States, 105,890 cases of gynecologic malignancies will be diagnosed, and 30,890 patients will die in 2016 [1]. Patients who develop brain metastases have a poor prognosis overall and require central nervous system control to improve their quality of life and ability to function [4]. Patients with gynecologic malignancies who develop brain metastases have a poor prognosis [4]. Aggressive treatment with surgery, focal therapy, and systemic therapy may improve patient outcomes [5,6,7,8]. Due to the rarity of this presentation, there are only a handful of studies describing outcomes of patients with gynecologic malignancies treated with Gamma Knife [7, 9,10,11]. We report the results of the Gamma Knife in the multimodality treatment of patients with gynecological cancers diagnosed with brain metastases
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