Abstract
PurposeSingle extracranial metastases from ovarian and uterine malignancies have historically been treated with surgery or conventional radiation. We report mature local control (LC), overall survival (OS), progression free survival (PFS), and toxicity for patients who completed 5-fraction stereotactic body radiation therapy (SBRT).MethodsPatients with biopsy-proven, single extracranial metastases from primary ovarian and uterine malignancies treated with 5-fraction SBRT were included. Patients were stratified based on tumor volume (small < 50 cc or large ≥ 50 cc) and dose (low dose < 35 Gy or high ≥ 35 Gy). Kaplan–Meier method was used to estimate LC, OS, and PFS.ResultsBetween July 2007 and July 2012, 20 patients underwent SBRT to a single extracranial metastasis. Primary site was divided evenly between ovarian and uterine (n = 10 each). Metastases involved the liver (30%), abdominal lymph nodes (25%), lung (20%), pelvic lymph nodes (10%), spine (10%), and extremity (5%). The median gross tumor volume (GTV) was 42.5 cc (range, 5–273 cc) and the median dose to the GTV was 35 Gy (range, 30–50 Gy). At a median follow-up of 56 months, the 5-year LC and OS estimates were 73 and 46%. When stratified by tumor volume, the 5-year LC and OS for small tumors were significantly better at 100% (p < 0.01) and 65% (p < 0.02). When stratified by dose, the 5-year LC was 87.5% with high dose and 53.6% with low dose (p = 0.035). The 5-year PFS for the entire cohort was 20%. Four patients with small metastases who had complete response remained disease free at study completion and were considered cured (median PFS > 10 years). Treatment was generally well tolerated, and only one patient experienced a late grade III musculoskeletal SBRT related toxicity.ConclusionsSBRT is a versatile, well-tolerated, and effective treatment option for single extracranial metastases from ovarian and uterine primary tumors. 35 Gy in five fractions appears to be a practical minimum effective dose. Four patients with small metastases were disease free at the study completion and considered cured. However, patients with larger metastases (≥50 cc) may require higher SBRT dosing or alternative treatments.
Highlights
Ovarian and uterine cancer remain the fifth [13,980] and sixth [12,160] leading causes of cancer related death in U.S women despite improvement in therapy [1]
We report the mature results from 20 consecutive patients with single extracranial metastases arising from previously eradicated ovarian and uterine primary tumors treated with 5-fraction robotic stereotactic body radiation therapy (SBRT)
Consecutive patients treated per an institutional protocol who had single extracranial metastases and a controlled ovarian or uterine primary tumor were eligible for this study
Summary
Ovarian and uterine cancer remain the fifth [13,980] and sixth [12,160] leading causes of cancer related death in U.S women despite improvement in therapy [1]. Aggressive local therapy in a selected patient population with an eradicated primary tumor and limited metastatic disease (≤5 metastases), has yielded promising results [2, 3]. For these oligometastatic patients, metastasectomy can provide lengthy disease-free intervals in conjunction with standard systemic therapies [4]. Not all patients are surgical candidates, either due to their comorbidities or unfavorable sites of metastases. In such cases, ablative radiation therapy may prove to be an ideal local therapy. The delivery of the high doses necessary to eradicate gross disease in the lung, liver, and peritoneal cavity leads to unacceptable toxicity with conventional techniques
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