Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
National Center for Tumor Diseases (NCT), Heidelberg, Baden-Württemberg, Germany.
Int J Gynecol Cancer. 2022 Feb;32(2):172-180. doi: 10.1136/ijgc-2021-002906. Epub 2021 Nov 30.
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.
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.
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).
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.
立体定向放射外科是治疗脑转移瘤的一种成熟治疗选择。存在多种用于预测放射治疗后生存的预后评分，但它们不是针对原发性盆腔妇科恶性肿瘤脑转移的特异性或经放射外科验证的评分。本研究旨在评估其可行性、安全性、结果和已建立的预后评分的影响。
我们回顾性地确定了 2008 年至 2021 年间接受放射治疗的 52 例脑转移瘤患者。31 例患者接受立体定向放射外科治疗，共治疗 75 个病灶；其余 21 例患者接受全脑放疗。采用 Kaplan-Meier 生存分析和对数秩检验计算和比较生存曲线，采用单因素和多因素 Cox 回归分析评估协变量对复发、局部控制和预后的影响。
中位随访时间为 10.7 个月，放射外科治疗后 1、2 和 5 年的总生存率分别为 65.3%、51.3%和 27.7%，明显高于全脑放疗组（p=0.049）。检测到 5 例局部失败（6.7%），导致 1 年和 2 年的局部脑控制率分别为 97.4%和 94.0%。预测总体生存良好的单因素包括高表现状态（p=0.030）和三种预后评分的应用，尤其是递归分区分析评分（p=0.028）。单因素和多因素分析表明，放射外科治疗前的颅外进展对总体生存有显著影响（p<0.0001）。5 例女性（16%）诊断为放射性坏死；与放射外科治疗相比，全脑放疗后的长期神经毒性明显更差（p=0.023）。
立体定向放射外科治疗盆腔妇科恶性肿瘤脑转移瘤似乎是安全且耐受良好的，可获得有前景的局部脑控制。预后评分具有可转移性，应推荐将放射外科作为原发性颅内治疗方法，特别是对于无先前颅外进展和递归分区分析 I 类的女性。
