Long Beverly, Eskander Ramez N, Tewari Krishnansu S
Beverly Long, Department of Obstetrics and Gynecology, University of California, Irvine Medical Center, Orange, CA 92868, United States.
World J Radiol. 2014 Jun 28;6(6):366-73. doi: 10.4329/wjr.v6.i6.366.
Recent retrospective studies have reported the use of stereotactic radiosurgery (SRS) in the treatment of gynecologic cancers. SRS uses real-time imaging and high dose radiation beams attached to precise robotic arms to target malignant lesions while sparing normal tissue. The purpose of this review is to examine the indications for SRS in gynecologic oncology, review the current literature regarding the use of SRS in gynecologic cancers, and identify future directions for research in this area. Literature on stereotactic radiosurgery was reviewed using the PubMed search engine. Articles written in English from 1993-2013 were reviewed, and 20 case series and clinical trials were included. The safety and efficacy SRS has been demonstrated in all gynecologic disease sites including cervical, endometrial, vulvar, vaginal, and ovarian cancers. Indications for its use include non-central pelvic recurrences in previously irradiated patients, complex or non-resectable disease recurrence, and solitary brain metastases. Toxicities are usually mild, though grade 3-4 toxicities have been reported. SRS is a promising second line treatment modality for patients with primary or recurrent disease who cannot undergo standard surgical or radiation therapy. Further research is required to determine optimal dosing and fractionation schedules, delineate appropriate patient populations, and assess longterm morbidity and survival.
近期的回顾性研究报道了立体定向放射外科（SRS）在妇科癌症治疗中的应用。SRS利用实时成像和连接在精确机械臂上的高剂量辐射束来靶向恶性病变，同时 sparing正常组织。本综述的目的是研究SRS在妇科肿瘤学中的适应症，回顾关于SRS在妇科癌症中应用的当前文献，并确定该领域未来的研究方向。使用PubMed搜索引擎对立体定向放射外科的文献进行了综述。对1993年至2013年用英文撰写的文章进行了综述，纳入了20个病例系列和临床试验。SRS的安全性和有效性已在包括宫颈癌、子宫内膜癌、外阴癌、阴道癌和卵巢癌在内的所有妇科疾病部位得到证实。其使用适应症包括既往接受过放疗患者的盆腔非中央复发、复杂或不可切除的疾病复发以及孤立性脑转移。毒性通常较轻，不过也有3 - 4级毒性的报道。对于无法接受标准手术或放疗的原发性或复发性疾病患者，SRS是一种有前景的二线治疗方式。需要进一步研究以确定最佳剂量和分割方案，明确合适的患者群体，并评估长期发病率和生存率。
