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  • Clinical Outcomes for Stereotactic Ablative Radiotherapy in Oligometastatic and Oligoprogressive Gynecological Malignancies

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Original Studies
Clinical Outcomes for Stereotactic Ablative Radiotherapy in Oligometastatic and Oligoprogressive Gynecological Malignancies
  1. Shane Mesko, MD, MBA,
  2. Kiri Sandler, MD,
  3. Joshua Cohen, MD,
  4. Gottfried Konecny, MD,
  5. Michael Steinberg, MD and
  6. Mitchell Kamrava, MD
  1. * School of Medicine, University of California Irvine, Irvine; and Departments of
  2. † Radiation Oncology,
  3. ‡ Gynecologic Oncology, and
  4. § Medical Oncology, University of California Los Angeles, Los Angeles, CA.
  1. Address correspondence and reprint requests to Mitchell Kamrava, MD, 200 UCLA Medical Plaza, Suite B265, Los Angeles, CA 90095. E-mail: mkamrava{at}mednet.ucla.edu.

Abstract

Objectives We report single-institution clinical outcomes of women treated with stereotactic ablative radiotherapy (SABR) for oligometastatic or progressive gynecological malignancies.

Materials and Methods From 2009 to 2015, 47 lesions from 28 patients were treated with SABR and retrospectively analyzed. All patients had oligometastatic (93%) or oligoprogressive (7%) disease. Primary cancer diagnoses were 15 ovarian, 8 endometrial, 2 cervical, 2 vaginal, and 1 uterine carcinosarcoma. Treatment was delivered using a median of 5 fractions to a median total dose of 40 Gy. Targets were grouped by treatment site and assessed for response using Response Evaluation Criteria in Solid Tumors v1.1. Mean biologically effective dose and pre-SABR tumor size were compared with response. Progression-free survival (PFS) was determined using Kaplan-Meier analysis, and toxicity outcomes were graded using Common Terminology Criteria for Adverse Events version 4.03.

Results Median follow-up was 12.8 months. Target locations were 17% liver, 21% lung, 17% paraaortic node, 26% other node, and 19% pelvic soft tissue. After treatment, 34% of targets were stable (SD), 32% had a partial response (PR), 17% had a complete response (CR), and 17% had progressive disease (PD). No failures occurred in lung or nodal targets. Mean ± standard deviation pre-SABR tumor diameter was 24 ± 22 mm. There was a significant difference in mean size between lesions that had a favorable (SD, PR, and CR) versus unfavorable response (PD) (17.2 vs 57.6 mm, P = 0.0044). Lesions that responded favorably were also more likely to have received a higher biologically effective dose (79.0 vs 59.6 Gy, P = 0.027). Median PFS was 10.8 months, and 1 patient experienced grade 3 toxicity.

Conclusions The SABR is a safe and effective local treatment modality in patients with oligometastatic gynecological disease. Distant progression remains the primary mode of failure in this patient population. In carefully selected patients, a combination of systemic treatment and SABR may offer long-term PFS.

  • Stereotactic ablative radiotherapy
  • Stereotactic body radiation therapy
  • Oligometastatic
  • Gynecological cancer
  • Clinical outcomes

https://doi.org/10.1097/IGC.0000000000000869

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    Footnotes

    • The authors declare no conflicts of interest.