Stereotactic body radiation therapy for oligometastatic gynecologic malignancies: A systematic review

Nikhil Yegya-Raman; Connie D Cao; Lara Hathout; Eugenia Girda; Scott D Richard; Norman G Rosenblum; Neil K Taunk; Salma K Jabbour

doi:10.1016/j.ygyno.2020.08.010

Stereotactic body radiation therapy for oligometastatic gynecologic malignancies: A systematic review

Gynecol Oncol. 2020 Nov;159(2):573-580. doi: 10.1016/j.ygyno.2020.08.010. Epub 2020 Sep 9.

Authors

Nikhil Yegya-Raman¹, Connie D Cao², Lara Hathout³, Eugenia Girda⁴, Scott D Richard⁵, Norman G Rosenblum⁵, Neil K Taunk¹, Salma K Jabbour⁶

Affiliations

¹ Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA.
² Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
³ Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA.
⁴ Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA.
⁵ Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
⁶ Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA. Electronic address: jabbousk@cinj.rutgers.edu.

PMID: 32917412
DOI: 10.1016/j.ygyno.2020.08.010

Abstract

Objective: To assess the efficacy and safety of stereotactic body radiation therapy (SBRT) for oligometastatic gynecologic malignancies.

Method: A comprehensive search of the PubMed, Medline, and EMBASE databases was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. "Oligometastatic" was defined as a limited number of uncontrolled/untreated metastatic lesions (typically ≤ 5), including regional nodal metastases. Primary outcomes were response rate (complete response or partial response), local control of oligometastatic lesions, and toxicity.

Results: Of 716 screened records, 17 studies (13 full length articles, 4 conference abstracts) were selected and analyzed as 16 unique studies. A total of 667 patients were treated with ~1071 metastatic lesions identified. Primary sites included ovarian (57.6%), cervical (27.1%), uterine (11.1%), vaginal (0.4%), vulvar (0.3%), and other/unspecified (3.4%). Most patients (65.4%) presented with a single metastatic lesion. Metastatic lesion sites included the abdomen (44.2%), pelvis (18.8%), thorax (15.5%), neck (4.6%), central nervous system (4.3%), bone (1.6%), and other/unspecified (11%). Of the lesions, 64% were nodal. Response rate (among 8 studies) ranged from 49% to 97%, with 7/8 studies reporting > 75% response rate. Local control ranged from 71% to 100%, with 14/16 studies reporting ≥ 80% local control. No grade ≥ 3 toxicities were observed in 9/16 (56%) studies. Median progression-free survival (PFS) (among 10 studies) ranged from 3.3 months to 21.7 months. Disease progression most commonly occurred outside of the SBRT radiation field (79% to 100% of failures).

Conclusions: SBRT for oligometastatic gynecologic malignancies is associated with favorable response and local control rates but a high rate of out-of-field progression and heterogeneous PFS. Additional study into rational combinations of SBRT and systemic therapy appears warranted to further improve patient outcomes.

Keywords: Gynecologic cancer; Local control; Oligometastatic; SBRT; Toxicity.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Aged
Female
Genital Neoplasms, Female / mortality
Genital Neoplasms, Female / radiotherapy*
Humans
Middle Aged
Neoplasm Metastasis / radiotherapy*
Progression-Free Survival
Radiosurgery / adverse effects
Radiosurgery / methods
Radiosurgery / statistics & numerical data*
Retrospective Studies

Grants and funding

P30 CA072720/CA/NCI NIH HHS/United States