Use of stereotactic radiosurgery in the treatment of gynecologic malignancies: A review

Table 1 Summary of case series of stereotactic radiosurgery

Ref.	n	Cancer types	Disease setting	Dose	Response/ control rate	Survival	Grade 3/4 toxicities	Patterns of failure
Molla et al[3]	16	Cervical (7)Uterine (9)	Primary (stage 1-3) and recurrence	EBRT 45 GyTSRS 14-20 Gy/2-5 fractions +/- para-aortic boost (2 pts)	15 pts NED at 12.6 mo (1 recurrence)	Not reported	Rectal bleeding (1)	Not reported
Deodato et al[13]	11	Ovarian (4)Cervical (4)Uterine (3)	Recurrence	SRS 20-30 Gy/4-6 fractions	83.3% overall response rate63% recurrence at 19 mo	Not reported	None	Systemic/distant progression (n = 4)Local progression (n = 1)Local and systemic progression (n = 1)
Guckenburger et al[7]	19	Cervical (12)Uterine (7)	Recurrence	EBRT 50 GySRS 15 Gy/3 fractions+/- vaginal BT (3 pts)	3 yr local control rate 81%	Median OS 25 mo, PFS 16 mo	Intestino-vaginal fistula (2)Small bowel ileus (1)	Systemic progression (n = 7)Local tumor progression (n = 1)Comorbid illness (n = 1)Unknown (n = 1)
Choi et al[10]	30	Cervical (28)Uterine (2)	Recurrence	EBRT 27-45 GySRS 13-45 Gy/1-3 fractions	4 yr local control rate 67.4%	Median PFS 32 mo	Various (5)	Locoregional failure (13.8%)Distant mets (10.3%)Local and distant failure (6.9%)
Dewas et al[9]	16	Cervical (4)Uterine (1)Rectal (4)Anal (6)Bladder (1)	Recurrence	EBRT 36-66 Gy (3 pts)SRS 36 Gy/6 fractions	1 yr local control rate 51.4%	Median OS 11.5 mo (DFS 8.3 mo)	None	Not reported
Haas et al[6]	6	Cervical (6)	Primary (stage 3B-4)	EBRT 45 GySRS 19.5-20 Gy/3-5 fractions+/- 50.4-61.2 Gy IMRT boost (5 pts)	100% local control at 14 mo	100% at 14 mo	None	Not reported
Hsieh et al[2]	9	Cervical (9)	Primary(stage 3B-4A)	EBRT 50.4 GySRS 15-27 Gy/5-9 fractions	3 yr local control rate 77.8%	Median OS 13 mo	Diarrhea (1)Thrombocytopenia (1)Rectal bleeding (3)Rectovaginal fistula (1)	Distant metastases (44%)
Hsieh et al[2]	31	Uterine (31)	Primary(stage 1B-3C)	IMRT or SRS via HT 45-50.4 Gy/25-28 fractionsICBT 4.5-5 Gy x 2-6 fractions	Not reported	Median OS 21 mo	None	Distant metastases
Kubicek et al[19]	11	Cervical 7)Uterine (2)Vaginal (2)	Primary(stage 2-3C) and recurrence	EBRT or IMRT 45-50.4 GySRS 5-27.5 Gy/1-5 fractions	Not reported	73% overall survival at follow-up	Rectal bleeding (1)	Not reported
Kunos et al[20]	3	Vulvar (3)	Recurrence	SRS 24 Gy/3 fractions	Not reported	1-3 mo PFS	None	Out of field recurrence
Kunos et al[15]	5	Endometrial (1) 0varian (3) Cervical (1)	Recurrence	SRS 5-8 Gy x 3-5 fractions	Not reported	Not reported	Fatigue (1)	Distant metastases
Kunos et al[1]Phase II trial	50	Cervix (9) Endometrial (14)Ovarian (25) Vulvar (2)	Recurrence	SRS 24 Gy/3 fractions	6 mo clinical benefit 68%	Median OS 20.2 mo	Hyperbilirubinemia (1)Enterovaginal fistula (1)	Out of fieldrecurrence (62%)

EBRT: External beam radiation therapy; SRS: Stereotactic radiosurgery; NED: No evidence of disease; BT: Brachytherapy; OS: Overall survival: HT: Helical tomotherapy; IMRT: Intensity modulated radiation therapy; PFS: Progression free survival.