Multicenter Retrospective Study of Stereotactic Radiosurgery for Gynecological Cancer Brain Metastases.

IF 3.9 2区医学 Q1 CLINICAL NEUROLOGY

Neurosurgery Pub Date : 2025-07-07 DOI:10.1227/neu.0000000000003609

Mathilde Billau, Andréanne Hamel, Jean-Nicolas Tourigny, Christian Iorio-Morin, Roman Liscak, Jaromir May, Ajay Niranjan, Zhishuo Wei, L Dade Lunsford, Diego D Luy, Shalini Jose, Sydney Scanlon, Joshua Silverman, Reed Mullen, Kenneth Bernstein, Douglas Kondziolka, Selcuk Peker, Yavuz Samanci, Steve Braunstein, Christina Phuong, Jason Sheehan, Stylianos Pikis, Jacob Kosyakovsky, Rahul Neal Prasad, Joshua David Palmer, David Bailey, Brad E Zacharia, Christopher P Cifarelli, Denisse Arteaga Icaza, Daniel T Cifarelli, Rodney E Wegner, Matthew J Shepard, Gregory N Bowden, Narine Wandrey, Chad G Rusthoven, Eric B Hintz, Michael Schulder, Anuj Goenka, Jennifer L Peterson, David Mathieu

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引用次数: 0

Abstract

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.

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立体定向放射外科治疗妇科肿瘤脑转移的多中心回顾性研究。

背景和目的：妇科癌症占女性癌症的10%至15%，但脑转移（BM）并不常见，关于其治疗的证据有限。本研究探讨立体定向放射手术（SRS）在原发性妇科肿瘤脑转移中的作用。方法：国际放射外科研究基金会各机构参与本研究。纳入标准要求组织学诊断为上皮性卵巢癌、宫颈癌或子宫内膜癌，2000年至2020年之间的SRS，至少1次影像学或临床随访。结果：共纳入276例977例BM的SRS患者。SRS的中位年龄为62岁（IQR， 55-70岁）。原发癌128例（46%）为卵巢癌，43例（16%）为宫颈癌，105例（38%）为子宫内膜癌。Karnofsky表现量表中位数为80%，124例（45%）患者有全身性疾病。平均每例患者治疗1例转移灶（IQR, 1-3）。中位个体转移体积为0.27 cc （IQR, 0.05-1.59 cc）。大多数（91%）接受单组分SRS，中位边缘剂量为18 Gy （IQR, 16-20 Gy）。精算总生存率在6、12和24个月分别为77%、65%和44%。生存恶化的预测因素包括年龄较大、宫颈和子宫内膜原发、既往全脑放射治疗（WBRT）、活动性全身性疾病、Karnofsky表现量表恶化、缺乏后续手术和BM数量增加。精算局部控制率在6个月时为94%，12个月时为89%，24个月时为78%。既往SRS或WBRT、肿瘤床治疗和宫颈组织学增加了局部失败的风险。44%和11%的患者分别出现了新的远程BM和脑脊膜播散。放射不良反应（ARE）发生在13%的病例中，但只有3%的病例有症状。既往WBRT或SRS和肿瘤直径增加增加了ARE的风险。结论：SRS是治疗有症状性ARE的低风险妇科肿瘤BM的有效方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurosurgery 医学-临床神经学

CiteScore

8.20

自引率

6.20%

发文量

898

审稿时长

2-4 weeks

期刊介绍： Neurosurgery, the official journal of the Congress of Neurological Surgeons, publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology, and medicine. For professionals aware of the rapid pace of developments in the field, this journal is nothing short of indispensable as the most complete window on the contemporary field of neurosurgery. Neurosurgery is the fastest-growing journal in the field, with a worldwide reputation for reliable coverage delivered with a fresh and dynamic outlook.