Johnston Hannah, McTyre Emory R, Cramer Cristina K, Lesser Glenn J, Ruiz Jimmy, Bourland J Daniel, Watabe Kounosuke, Lo Hui-Wen, Qasem Shadi, Laxton Adrian W, Tatter Stephen B, Chan Michael D
Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
Department of Medicine (Hematology and Oncology), Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
J Radiosurg SBRT. 2017;5(1):55-61.
Brain metastases from gynecologic primary cancers are rare events, but they can be a cause of morbidity and mortality when they occur.
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.
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).
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.
妇科原发性癌症脑转移是罕见事件，但一旦发生，可能导致发病和死亡。
这是一项针对接受伽玛刀立体定向放射外科治疗（SRS）的妇科原发性癌症脑转移患者的单机构回顾性研究。2000年至2013年期间，本机构共对33例妇科原发性癌症脑转移患者进行了SRS治疗，其中包括宫颈癌（n = 2）、子宫内膜癌（n = 6）和卵巢癌（n = 25）。通过查阅电子病历确定患者的生存率、失败模式和死亡原因。
整个人群1年、2年和5年的总生存率分别为47.1%、21.7%和14.5%。原发性癌症之间的生存率无差异（对数秩检验p = 0.33）。36.4%的患者死于神经功能衰竭。整个人群1年和2年的局部失败率分别为10.4%和14.3%。原发性癌症之间的局部失败率无差异。整个人群1年、2年和5年的远处脑转移失败率分别为20.6%、27.7%和31.3%。多因素Cox比例风险分析显示，年龄是总生存的唯一预测因素（HR = 1.03，p = 0.01）。卵巢癌患者远处脑转移失败风险降低（HR = 0.17，p = 0.005），而宫颈癌患者远处脑转移失败风险增加（HR = 35.7，p = 0.001）。
SRS是妇科癌症脑转移患者的一种可行治疗选择。年龄较小是一个积极的预后因素。卵巢癌患者远处脑转移失败风险较低。
