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Stereotactic radiosurgery for brain metastases from pelvic gynecological malignancies: oncologic outcomes, validation of prognostic scores, and dosimetric evaluation
  1. Eva Meixner1,2,
  2. Tanja Eichkorn1,2,
  3. Sinem Erdem1,
  4. Laila König1,2,
  5. Kristin Lang1,2,
  6. Jonathan W Lischalk3,
  7. Laura L Michel2,4,
  8. Andreas Schneeweiss2,4,
  9. Katharina Smetanay2,4,
  10. Jürgen Debus1,2 and
  11. Juliane Hörner-Rieber1,2
  1. 1 Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
  2. 2 National Center for Tumor Diseases (NCT), Heidelberg, Baden-Württemberg, Germany
  3. 3 Department of Radiation Oncology, New York University Langone Health, New York, New York, USA
  4. 4 Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Baden-Württemberg, Germany
  1. Correspondence to Dr Eva Meixner, Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Baden-Württemberg, Germany; Eva.Meixner{at}med.uni-heidelberg.de

Abstract

Introduction Stereotactic radiosurgery is a well-established treatment option in the management of brain metastases. Multiple prognostic scores for prediction of survival following radiotherapy exist, but are not disease-specific or validated for radiosurgery in women with primary pelvic gynecologic malignancies metastatic to the brain. The aim of the present study is to evaluate the feasibility, safety, outcomes, and impact of established prognostic scores.

Methods We retrospectively identified 52 patients treated with radiotherapy for brain metastases between 2008 and 2021. Stereotactic radiosurgery was utilized in 31 patients for an overall number of 75 lesions; the remaining 21 patients received whole-brain radiotherapy. Kaplan-Meier survival analysis and the log-rank test were used to calculate and compare survival curves and univariate and multivariate Cox regression to assess the influence of cofactors on recurrence, local control, and prognosis.

Results With a median follow-up of 10.7 months, overall survival rates post radiosurgery were 65.3%, 51.3%, and 27.7% for 1, 2, and 5 years, respectively, which were significantly higher than post whole-brain radiotherapy (p=0.049). Five local failures (6.7%) were detected, resulting in 1 and 2 year local cerebral control rates of 97.4% and 94.0%, respectively. Univariate factors for prediction of superior overall survival were high performance status (p=0.030) and application of three prognostic scores, especially the Recursive Partitioning Analysis score (p=0.028). Uni- and multivariate analysis revealed that extracranial progression prior to radiosurgery was significant for inferior overall survival (p<0.0001). Radionecrosis was diagnosed in five women (16%); long-term neurotoxicity was significantly worse after whole-brain radiotherapy compared with radiosurgery (p=0.023).

Conclusion Stereotactic radiosurgery for brain metastases from pelvic gynecologic malignancies appears to be safe and well tolerated, achieving promising local cerebral control. Prognostic scores were shown to be transferable and radiosurgery should be recommended as primary intracranial treatment, especially in women with no prior extracranial progression and Recursive Partitioning Analysis class I.

  • cervical cancer
  • ovarian cancer
  • uterine cancer
  • radiation oncology
  • vulvar and vaginal cancer

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Contributors EM: data curation, guarantor, statistical analysis, investigation, validation, method-ology, visualization, writing-original draft, writing-review, project administration, editing. ES, LK, KL, JWL, LLM, AS, KS, JD: validation, writing-review, editing. JH-R: data curation, statistical analysis, investigation, validation, methodology, visualization, writing-original draft, writing-review, project administration, supervision, editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests EM received speaker fees from Elekta outside the submitted work. LK received speaker fees and travel reimbursement from Accuray International Sàrl, and NovoCure outside the submitted work. JD received grants from Accuray International Sàrl, Merck Serono GmbH, CRI – The Clinical Research Institute GmbH, View Ray Inc, Accuray Incorporated, RaySearch Laboratories AB, Vision RT limited, Astellas Pharma GmbH, AstraZeneca GmbH, Solution Akademie GmbH, Ergomed PLC Surrey Research Park, Siemens Healthcare GmbH, Quintiles GmbH, NovoCure, Pharmaceutical Research Associates GmbH, Boehringer Ingelheim Pharma GmbH Co, PTW-Freiburg Dr. Pychlau GmbH, Nanobiotix A.A. and IntraOP Medical outside the submitted work. JH-R received speaker fees and travel reimbursement from ViewRay Inc, travel reimbursement from IntraOP Medical and Elekta Instrument AB, a grant from IntraOP Medical outside the submitted work.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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