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
{"title":"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。","authors":"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","doi":"10.1227/neu.0000000000003609","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>SRS is an effective management for BM from gynecological cancers with low risks of symptomatic ARE.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9000,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Multicenter Retrospective Study of Stereotactic Radiosurgery for Gynecological Cancer Brain Metastases.\",\"authors\":\"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\",\"doi\":\"10.1227/neu.0000000000003609\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>SRS is an effective management for BM from gynecological cancers with low risks of symptomatic ARE.</p>\",\"PeriodicalId\":19276,\"journal\":{\"name\":\"Neurosurgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.9000,\"publicationDate\":\"2025-07-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neurosurgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1227/neu.0000000000003609\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1227/neu.0000000000003609","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Multicenter Retrospective Study of Stereotactic Radiosurgery for Gynecological Cancer Brain Metastases.
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.
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.
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