TY - JOUR
T1 - Multicenter Retrospective Study of Stereotactic Radiosurgery for Gynecological Cancer Brain Metastases
AU - Billau, Mathilde
AU - Hamel, Andréanne
AU - Tourigny, Jean Nicolas
AU - Iorio-Morin, Christian
AU - Liscak, Roman
AU - May, Jaromir
AU - Niranjan, Ajay
AU - Wei, Zhishuo
AU - Lunsford, L. Dade
AU - Luy, Diego D.
AU - Jose, Shalini
AU - Scanlon, Sydney
AU - Silverman, Joshua
AU - Mullen, Reed
AU - Bernstein, Kenneth
AU - Kondziolka, Douglas
AU - Peker, Selcuk
AU - Samanci, Yavuz
AU - Braunstein, Steve
AU - Phuong, Christina
AU - Sheehan, Jason
AU - Pikis, Stylianos
AU - Kosyakovsky, Jacob
AU - Prasad, Rahul Neal
AU - Palmer, Joshua David
AU - Bailey, David
AU - Zacharia, Brad E.
AU - Cifarelli, Christopher P.
AU - Icaza, Denisse Arteaga
AU - Cifarelli, Daniel T.
AU - Wegner, Rodney E.
AU - Shepard, Matthew J.
AU - Bowden, Gregory N.
AU - Wandrey, Narine
AU - Rusthoven, Chad G.
AU - Hintz, Eric B.
AU - Schulder, Michael
AU - Goenka, Anuj
AU - Peterson, Jennifer L.
AU - Mathieu, David
N1 - Publisher Copyright:
© Congress of Neurological Surgeons 2025.
PY - 2025
Y1 - 2025
N2 - BACKGROUND AND OBJECTIVES:Gynecological cancers represent 10% to 15% of cancers in women, but brain metastases (BM) are uncommon, with limited evidence regarding their management. This study investigates the role of stereotactic radiosurgery (SRS) for BM from primary gynecological cancers.METHODS:Institutions of the International Radiosurgery Research Foundation participated in this study. Inclusion criteria required histological diagnosis of epithelial ovarian, cervical, or endometrial cancer, SRS between 2000 and 2020, and at least 1 imaging or clinical follow-up.RESULTS:A total of 276 patients having SRS for 977 BM were included. Median age at SRS was 62 years (IQR, 55-70). Primary cancer origin was ovarian in 128 (46%), cervical in 43 (16%), and endometrial in 105 patients (38%). Median Karnofsky Performance Scale was 80%, and systemic disease was active in 124 (45%) of patients. A median of 1 metastasis was treated (IQR, 1-3) per patient. Median individual metastasis volume was 0.27 cc (IQR, 0.05-1.59 cc). The majority (91%) received single-fraction SRS, using a median margin dose of 18 Gy (IQR, 16-20 Gy). Actuarial overall survival was 77%, 65%, and 44% at 6, 12, and 24 months, respectively. Predictors of worsened survival included older age, cervical and endometrial primary, previous whole-brain radiation therapy (WBRT), active systemic disease, worsened Karnofsky Performance Scale, absence of subsequent surgery, and increasing number of BM. Actuarial local control was 94% at 6 months, 89% at 12 months, and 78% at 24 months. Previous SRS or WBRT, tumor bed treatment, and cervical histology increased the risk of local failure. New remote BM and leptomeningeal dissemination occurred in 44% and 11% of patients, respectively. Adverse radiation effects (ARE) occurred in 13% of cases but were symptomatic in only 3%. Previous WBRT or SRS and increased tumor diameter increased the risk of ARE.CONCLUSION:SRS is an effective management for BM from gynecological cancers with low risks of symptomatic ARE.
AB - BACKGROUND AND OBJECTIVES:Gynecological cancers represent 10% to 15% of cancers in women, but brain metastases (BM) are uncommon, with limited evidence regarding their management. This study investigates the role of stereotactic radiosurgery (SRS) for BM from primary gynecological cancers.METHODS:Institutions of the International Radiosurgery Research Foundation participated in this study. Inclusion criteria required histological diagnosis of epithelial ovarian, cervical, or endometrial cancer, SRS between 2000 and 2020, and at least 1 imaging or clinical follow-up.RESULTS:A total of 276 patients having SRS for 977 BM were included. Median age at SRS was 62 years (IQR, 55-70). Primary cancer origin was ovarian in 128 (46%), cervical in 43 (16%), and endometrial in 105 patients (38%). Median Karnofsky Performance Scale was 80%, and systemic disease was active in 124 (45%) of patients. A median of 1 metastasis was treated (IQR, 1-3) per patient. Median individual metastasis volume was 0.27 cc (IQR, 0.05-1.59 cc). The majority (91%) received single-fraction SRS, using a median margin dose of 18 Gy (IQR, 16-20 Gy). Actuarial overall survival was 77%, 65%, and 44% at 6, 12, and 24 months, respectively. Predictors of worsened survival included older age, cervical and endometrial primary, previous whole-brain radiation therapy (WBRT), active systemic disease, worsened Karnofsky Performance Scale, absence of subsequent surgery, and increasing number of BM. Actuarial local control was 94% at 6 months, 89% at 12 months, and 78% at 24 months. Previous SRS or WBRT, tumor bed treatment, and cervical histology increased the risk of local failure. New remote BM and leptomeningeal dissemination occurred in 44% and 11% of patients, respectively. Adverse radiation effects (ARE) occurred in 13% of cases but were symptomatic in only 3%. Previous WBRT or SRS and increased tumor diameter increased the risk of ARE.CONCLUSION:SRS is an effective management for BM from gynecological cancers with low risks of symptomatic ARE.
UR - https://www.scopus.com/pages/publications/105010281068
UR - https://www.scopus.com/inward/citedby.url?scp=105010281068&partnerID=8YFLogxK
U2 - 10.1227/neu.0000000000003609
DO - 10.1227/neu.0000000000003609
M3 - Article
AN - SCOPUS:105010281068
SN - 0148-396X
JO - Neurosurgery
JF - Neurosurgery
M1 - 10.1227/neu.0000000000003609
ER -
