Role of Gamma Knife® Radiosurgery for the Treatment of Brain Metastases from Gynecological Cancers

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).

Brain Metastases from Uterine Cervical and Endometrial Cancer

“…We also observed that only case reports, case series, and retrospective database studies provided information on number of patients, incidence rates, clinicopathological features, symptoms, and types of treatments. After screening the titles and abstracts, 83 full texts on BMs from CC and 78 full texts on BM from EC were selected and summarized (Table 1 and Table S1 [9,, Table 2 and Table S2 [6,9,20,28,31,37,40,41,46,49,53,55,59,62,63,[66][67][68][69][70][71][72][73][74][75][77][78][79]81,82,84,). Several case reports about the FIGO stage were lacking, and only histologic information was described.…”

“…There was no information on the overall survival of the patients in 20 case reports/case series. The survival times after the diagnosis of BMs with regard to the mode of therapy of BMs from CC were as follows [ 11 , 14 , 16 , 18 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 65 , 66 , 70 , 71 , 72 , 73 , 74 , 76 ,…”

“…The survival of BMs from EC is very poor, and depends on the status of the primary lesion, the presence of extracranial metastases, and the volume, number, and site of metastases in the brain parenchyma. The survival time after diagnosis of BMs from EC was available for 946 patients in the literature and ranged from 0.1 to 171 months (median: 7.5 months) [ 6 , 9 , 28 , 31 , 37 , 40 , 41 , 46 , 49 , 53 , 55 , 59 , 62 , 63 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 77 , 78 , 79 , 81 , 82 , 84 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 ...…”

Linear accelerator-based radiosurgery and hypofractionated stereotactic radiotherapy for brain metastasis secondary to gynecologic malignancies: A single institution series examining outcomes of a rare entity

“…Treatment of brain metastasis include surgical resection, irradiation, chemotherapy, and pharmacologic reduction of intracranial pressure. Given the difficulty of chemotherapeutic drugs to penetrate the blood-brain barrier, whole beam radiation therapy (WBRT) has served as the standard palliative therapy for BM, with a median survival rate of 2.5–4.5 months ( Anupol et al, 2002 ; Keller et al, 2016 ; Kim et al, 2017 ). Also, administration of WBRT is associated with improvement of neurologic function in 50% of patients, with 70–80% citing an improved or stable neurologic state throughout their remaining life span ( Ling et al, 2015 ).…”

“…However, omission of WBRT has been shown to increase the risk of recurrent BM in patients, therefore surgical intervention (or SRS) with WBRT is frequently used to maximize disease control ( Kim et al, 2017 ). Previous studies have shown that multimodal therapy that included surgery followed by adjuvant radiation and chemotherapy for solitary brain metastasis further increase median survival to 12–20 months, citing longer duration of neurologic improvement and lower rate of recurrence than patients treated with WBRT alone ( Kasper et al, 2017 ; Keller et al, 2016 ; Ling et al, 2015 ).…”