Published online Jun 28, 2014. doi: 10.4329/wjr.v6.i6.366
Revised: April 1, 2014
Accepted: April 17, 2014
Published online: June 28, 2014
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.
Core tip: Stereotactic radiosurgery is a novel treatment modality in gynecologic oncology. Its use has been reported for inoperable primary tumors, recurrent tumors in or near irradiated fields, and isolated pelvic nodal metastases. Associated toxicities are usually mild. Though further research is needed to establish the role of SRS in gynecologic oncology, it represents an important second line therapy in appropriately selected patients.