Stereotactic radiosurgery in the treatment of brain metastases from gynecologic primary cancer
Hannah Johnston, Emory R. McTyre, Cristina K. Cramer, Glenn J. Lesser, Jimmy Ruiz, J. Daniel Bourland, Kounosuke Watabe, Hui-Wen Lo, Shadi Qasem, Adrian W. Laxton, Stephen B. Tatter and Michael D. Chan
Background: Brain metastases from gynecologic primary cancers are rare events, but they can be a cause of morbidity and mortality when they occur.
Methods: This is a single institution retrospective study on patients with brain metastases from gynecologic primary cancer who received Gamma Knife stereotactic radiosurgery (SRS). Between 2000 and 2013, a total of 33 patients with brain metastases from gynecologic primary including cervical (n=2), endometrial (n=6) and ovarian cancers (n=25) were treated with SRS at our institution. Electronic medical records were reviewed to determine survival, patterns of failure and cause of death.
Results: Overall survival at 1, 2 and 5 years for the entire population was 47.1%, 21.7%, and 14.5%, respectively. There was no difference in survival between the primary cancers (log-rank p = 0.33). 36.4% patients died of neurologic death. Local failure at 1 and 2 years for the entire population was 10.4% and 14.3%, respectively. There was no difference in local failure between the primary cancers. Distant brain failure at 1, 2 and 5 years for the entire population was 20.6%, 27.7%, and 31.3%, respectively. On multivariate Cox Proportional Hazards analysis, age was the only predictor of overall survival (HR = 1.03, p = 0.01). Ovarian cancer patients had decreased risk of distant brain failure (HR = 0.17, p=0.005), whereas cervical cancer patients had an increased risk of distant brain failure (HR = 35.7, p = 0.001).
Conclusions: SRS represents a feasible treatment option for patients with brain metastases from gynecologic cancer. Younger age is a positive prognostic factor. Ovarian cancer patients have lower risk of distant brain failure.
Keywords: stereotactic radiosurgery (SRS), gynecological cancer, Gamma Knife (GKS), metastases