Role of Gamma Knife® Radiosurgery for the Treatment of Brain Metastases from Gynecological Cancers.
OBJECTIVE
Gamma Knife®(GK) (Elekta Instruments, Stockholm, Sweden) radiosurgery is well established for treatment of brain metastases. There are limited data on patients treated with GK from gynecological cancers. The authors sought to determine the effectiveness of the GK in patients with brain metastases from gynecological cancers.


METHODS
An IRB-approved database was queried for patients with gynecologic cancers treated with GK between June 1996 and May 2016. Imaging studies were reviewed post-SRS (stereotactic radiosurgery) to evaluate local control (LC) and distant brain control (DC). Overall survival (OS), local control, and distant brain control were calculated using the Kaplan-Meier (KM) method and log-rank test.  Results: Thirty-three patients underwent SRS for 73 separate cranial lesions. The median age was -58.5 years, and 17 (52%) also had extracranial metastases. Ten (30%) patients had previously received whole brain radiotherapy (WBRT), and 11 (33%) underwent concurrent WBRT. The median tumor volume was 0.96 cm3. Median radiographic follow-up was 11 months. At the time of treatment, 39% of patients were categorized as recursive partitioning analysis (RPA) Class I, 55% as RPA Class II, and 6% as RPA Class III. The local failure rate was 8%. Five patients (15%) developed new brain lesions outside the radiation field with a median progression-free survival (PFS) of seven (range: 3-9) months. Median OS was 15 months from GK treatment. One-year OS was 72.9% from GK treatment. Primary cancer histology was a significant predictor of OS, favoring ovarian and endometrial cancer (p = 0.03).


CONCLUSIONS
Gamma Knife stereotactic radiosurgery for gynecologic brain metastases leads to excellent control rates of treated lesions. Primary histology may have a significant impact on OS following GK, with improved survival seen with ovarian and cervical cancer following Gamma Knife radiosurgery (p = 0.03).
College of Medicine, University of Central Florida.
Andrew
A
Keller
College of Medicine, University of Central Florida.
Rahim
R
Ismail
Radiation Oncology, Florida Hospital.
Peter S
PS
Potrebko
Research Services, Florida Hospital.
Julie
J
Pepe
Quality Improvement, Florida Hospital.
Meiling
M
Wu
Radiation Oncology, Florida Hospital.
Kunal
K
Saigal
Radiation Oncology, Florida Hospital.
Matthew
M
Biagioli
Radiation Oncology, Florida Hospital.
Ravi
R
Shridhar
Gynecologic Oncology, Florida Hospital.
Robert
R
Holloway
Neurosurgery, Florida Hospital.
Melvin
M
Field
Radiation Oncology, Florida Hospital.
Nikhil G
NG
Rao
brain metastases; gamma knife radiosurgery; gynecological cancers; stereotactic radiosurgery