Skip to main content

Advertisement

SpringerLink
Log in

Stereotactic Ablative Radiotherapy for Recurrent or Metastatic Gynecological Cancer: Extending Lives?

  • Gynecologic Cancers (LA Cantrell, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Recent phase II clinical trials suggest that stereotactic ablative radiation therapy (SABR) can potentially improve survival for patients with oligometastatic cancer. However, these studies have mostly enrolled primaries other than gynecologic malignancies. While level I evidence is limited, recent publications exploring the use of SABR for oligometastatic gynecologic cancers have indicated a potential role for this treatment in para-aortic lymph node recurrences, and in visceral and brain metastases. The use of SABR for recurrences in the pelvis presents a number of challenges as these patients have often received previous radiation treatment. In these settings, care must be taken to avoid trespassing normal tissue tolerance with SABR leading to toxicity, especially as the potential benefit of SABR in this setting is not based on high-level evidence. Although SABR is feasible and in general safe for oligometastatic gynecologic malignancies, insufficient data are available to indicate whether it is associated with improved survival. Clinical judgment that incorporates patient and tumor factors is needed to determine if SABR is appropriate for selecting patients. Future directions include combining SABR with novel systemic therapies, determining optimal sequencing of treatments, and generating more robust randomized data pertaining to the use of SABR for oligometastatic gynecologic cancers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Hellman S, Weichselbaum RR. Oligometastases. J Clin Oncol. 1995;13(1):8–10.

    CAS  PubMed  Google Scholar 

  2. Morris EJ, Forman D, Thomas JD, Quirke P, Taylor EF, Fairley L, et al. Surgical management and outcomes of colorectal cancer liver metastases. Br J Surg. 2010;97(7):1110–8.

    CAS  PubMed  Google Scholar 

  3. Lewis SL, Porceddu S, Nakamura N, Palma DA, Lo SS, Hoskin P, et al. Definitive stereotactic body radiotherapy (SBRT) for extracranial oligometastases: an international survey of >1000 radiation oncologists. Am J Clin Oncol. 2017;40(4):418–22.

    PubMed  Google Scholar 

  4. Videtic GMM, Donington J, Giuliani M, Heinzerling J, Karas TZ, Kelsey CR, et al. Stereotactic body radiation therapy for early-stage non-small cell lung cancer: executive summary of an ASTRO evidence-based guideline. Pract Radiat Oncol. 2017;7(5):295–301.

    PubMed  Google Scholar 

  5. Senan S, Palma DA, Lagerwaard FJ. Stereotactic ablative radiotherapy for stage I NSCLC: recent advances and controversies. J Thorac Dis. 2011;3(3):189–96.

    PubMed  PubMed Central  Google Scholar 

  6. • Palma DA, Olson R, Harrow S, Gaede S, Louie AV, Haasbeek C, et al. Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): a randomised, phase 2, open-label trial. Lancet. 2019;393(10185):2051–8. Recent randomized phase II trials studying the use of SABR for oligometastatic disease from different primary cancers, suggesting survival benefit.

  7. • Gomez DR, Tang C, Zhang J, Blumenschein GR Jr, Hernandez M, Lee JJ, et al. Local consolidative therapy vs. maintenance therapy or observation for patients with oligometastatic non-small-cell lung cancer: long-term results of a multi-institutional, phase II, randomized study. J Clin Oncol. 2019;37(18):1558–65. Recent randomized phase II trials studying the use of SABR for oligometastatic disease from different primary cancers, suggesting survival benefit.

  8. • Ost P, Reynders D, Decaestecker K, Fonteyne V, Lumen N, De Bruycker A, et al. Surveillance or metastasis-directed therapy for oligometastatic prostate cancer recurrence: a prospective, randomized, multicenter phase II trial. J Clin Oncol. 2018;36(5):446–53 Recent randomized phase II trials studying the use of SABR for oligometastatic disease from different primary cancers, suggesting survival benefit.

  9. Radwan N, Phillips R, Ross A, Rowe SP, Gorin MA, Antonarakis ES, et al. A phase II randomized trial of Observation versus stereotactic ablative RadiatIon for OLigometastatic prostate CancEr (ORIOLE). BMC Cancer. 2017;17(1):453.

    PubMed  PubMed Central  Google Scholar 

  10. Ning MS, Ahobila V, Jhingran A, Stecklein SR, Frumovitz M, Schmeler KM, et al. Outcomes and patterns of relapse after definitive radiation therapy for oligometastatic cervical cancer. Gynecol Oncol. 2018;148(1):132–8.

    PubMed  Google Scholar 

  11. Guckenberger M, Bachmann J, Wulf J, Mueller G, Krieger T, Baier K, et al. Stereotactic body radiotherapy for local boost irradiation in unfavourable locally recurrent gynaecological cancer. Radiother Oncol. 2010;94(1):53–9.

    PubMed  Google Scholar 

  12. Seo Y, Kim MS, Yoo HJ, Jang WI, Rhu SY, Choi SC, et al. Salvage stereotactic body radiotherapy for locally recurrent uterine cervix cancer at the pelvic sidewall: feasibility and complication. Asia Pac J Clin Oncol. 2016;12(2):e280–8.

    PubMed  Google Scholar 

  13. Deodato F, Macchia G, Grimaldi L, Ferrandina G, Lorusso D, Salutari V, et al. Stereotactic radiotherapy in recurrent gynecological cancer: a case series. Oncol Rep. 2009;22(2):415–9.

    PubMed  Google Scholar 

  14. Dewas S, Bibault JE, Mirabel X, Nickers P, Castelain B, Lacornerie T, et al. Robotic image-guided reirradiation of lateral pelvic recurrences: preliminary results. Radiat Oncol. 2011;6:77.

    PubMed  PubMed Central  Google Scholar 

  15. Abusaris H, Hoogeman M, Nuyttens JJ. Re-irradiation: outcome, cumulative dose and toxicity in patients retreated with stereotactic radiotherapy in the abdominal or pelvic region. Technol Cancer Res Treat. 2012;11(6):591–7.

    PubMed  PubMed Central  Google Scholar 

  16. Hasan S, Ricco A, Jenkins K, Lanciano R, Hanlon A, Lamond J, et al. Survival and control prognosticators of recurrent gynecological malignancies of the pelvis and para-aortic region treated with stereotactic body radiation therapy. Front Oncol. 2016;6:249.

    PubMed  PubMed Central  Google Scholar 

  17. Choi CW, Cho CK, Yoo SY, Kim MS, Yang KM, Yoo HJ, et al. Image-guided stereotactic body radiation therapy in patients with isolated para-aortic lymph node metastases from uterine cervical and corpus cancer. Int J Radiat Oncol Biol Phys. 2009;74(1):147–53.

    PubMed  Google Scholar 

  18. Bignardi M, Navarria P, Mancosu P, Cozzi L, Fogliata A, Tozzi A, et al. Clinical outcome of hypofractionated stereotactic radiotherapy for abdominal lymph node metastases. Int J Radiat Oncol Biol Phys. 2011;81(3):831–8.

    PubMed  Google Scholar 

  19. Bonomo P, Cipressi S, Saieva C, Greto D, Masi L, Paiar F, et al. Clinical outcome of stereotactic body radiotherapy for abdominal lymph node metastases. Tumori. 2013;99(5):611–6.

    PubMed  Google Scholar 

  20. • Kunos CA, Brindle J, Waggoner S, Zanotti K, Resnick K, Fusco N, et al. Phase II clinical trial of robotic stereotactic body radiosurgery for metastatic gynecologic malignancies. Front Oncol. 2012;2:181 Phase II trial on the use of SABR for metastases specifically from gynecological cancer histologies showing excellent response and local control rates.

  21. • Mesko S, Sandler K, Cohen J, Konecny G, Steinberg M, Kamrava M. Clinical outcomes for stereotactic ablative radiotherapy in oligometastatic and oligoprogressive gynecological malignancies. Int J Gynecol Cancer. 2017;27(2):403–8 Recent study on the use of SABR specifically for metastatic disease from gynecological malignancies with promising results.

  22. Iftode C, D'Agostino GR, Tozzi A, Comito T, Franzese C, De Rose F, et al. Stereotactic body radiation therapy in oligometastatic ovarian cancer: a promising therapeutic approach. Int J Gynecol Cancer. 2018;28(8):1507–13.

    PubMed  Google Scholar 

  23. •• Lazzari R, Ronchi S, Gandini S, Surgo A, Volpe S, Piperno G, et al. Stereotactic body radiation therapy for oligometastatic ovarian cancer: a step toward a drug holiday. Int J Radiat Oncol Biol Phys. 2018;101(3):650–60 One of the largest recent series studying the use of SABR for oligometastatic ovarian cancer shows that SABR led to promising control rates and may delay the need for additional systemic treatment.

  24. Macchia G, Deodato F, Cilla S, Torre G, Corrado G, Legge F, et al. Volumetric intensity modulated arc therapy for stereotactic body radiosurgery in oligometastatic breast and gynecological cancers: feasibility and clinical results. Oncol Rep. 2014;32(5):2237–43.

    PubMed  Google Scholar 

  25. • Matsunaga S, Shuto T, Sato M. Gamma Knife surgery for metastatic brain tumors from gynecologic cancer. World Neurosurg. 2016;89:455–63 One of the largest series studying the use of stereotactic radiation for brain metastases specifically from gynecologic cancer histologies, with excellent local control rates.

  26. Gigliotti MJ, Hasan S, Fuhrer R, Krivak T, Aziz K, Wegner RE. Linear accelerator-based radiosurgery and hypofractionated stereotactic radiotherapy for brain metastasis secondary to gynecologic malignancies: a single institution series examining outcomes of a rare entity. Gynecol Oncol Rep. 2018;25:19–23.

    PubMed  PubMed Central  Google Scholar 

  27. Keller A, Ismail R, Potrebko PS, Pepe J, Wu M, Saigal K, et al. Role of Gamma Knife(R) radiosurgery for the treatment of brain metastases from gynecological cancers. Cureus. 2016;8(12):e947.

    PubMed  PubMed Central  Google Scholar 

  28. Haasbeek CJ, Uitterhoeve AL, van der Velden J, Gonzalez DG, Stalpers LJ. Long-term results of salvage radiotherapy for the treatment of recurrent cervical carcinoma after prior surgery. Radiother Oncol. 2008;89(2):197–204.

    PubMed  Google Scholar 

  29. Thomas GM, Dembo AJ, Myhr T, Black B, Pringle JF, Rawlings G. Long-term results of concurrent radiation and chemotherapy for carcinoma of the cervix recurrent after surgery. Int J Gynecol Cancer. 1993;3(4):193–8.

    PubMed  Google Scholar 

  30. Maneo A, Landoni F, Cormio G, Colombo A, Placa F, Pellegrino A, et al. Concurrent carboplatin/5-fluorouracil and radiotherapy for recurrent cervical carcinoma. Ann Oncol. 1999;10(7):803–7.

    CAS  PubMed  Google Scholar 

  31. Ijaz T, Eifel PJ, Burke T, Oswald MJ. Radiation therapy of pelvic recurrence after radical hysterectomy for cervical carcinoma. Gynecol Oncol. 1998;70(2):241–6.

    CAS  PubMed  Google Scholar 

  32. Jain P, Hunter RD, Livsey JE, Coyle C, Swindell R, Davidson SE. Salvaging locoregional recurrence with radiotherapy after surgery in early cervical cancer. Clin Oncol (R Coll Radiol). 2007;19(10):763–8.

    CAS  PubMed  Google Scholar 

  33. •• Mendez LC, Leung E, Cheung P, Barbera L. The role of stereotactic ablative body radiotherapy in gynaecological cancers: a systematic review. Clin Oncol (R Coll Radiol). 2017;29(6):378–84 Systematic review outlining the use of SABR in various applications for gynecological malignancies, including treatment of primary tumors and treatment of recurrent or metastatic disease.

  34. de Wit R, van der Zee J, van der Burg ME, Kruit WH, Logmans A, van Rhoon GC, et al. A phase I/II study of combined weekly systemic cisplatin and locoregional hyperthermia in patients with previously irradiated recurrent carcinoma of the uterine cervix. Br J Cancer. 1999;80(9):1387–91.

    PubMed  PubMed Central  Google Scholar 

  35. Lee SY, Lee NR, Cho DH, Kim JS. Treatment outcome analysis of chemotherapy combined with modulated electro-hyperthermia compared with chemotherapy alone for recurrent cervical cancer, following irradiation. Oncol Lett. 2017;14(1):73–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  36. Chiantera V, Rossi M, De Iaco P, Koehler C, Marnitz S, Fagotti A, et al. Morbidity after pelvic exenteration for gynecological malignancies: a retrospective multicentric study of 230 patients. Int J Gynecol Cancer. 2014;24(1):156–64.

    PubMed  Google Scholar 

  37. Pontoriero A, Iati G, Aiello D, Pergolizzi S. Stereotactic radiotherapy in the retreatment of recurrent cervical cancers, assessment of toxicity, and treatment response: initial results and literature review. Technol Cancer Res Treat. 2016;15(6):759–65.

    PubMed  Google Scholar 

  38. Kunos C, Chen W, DeBernardo R, Waggoner S, Brindle J, Zhang Y, et al. Stereotactic body radiosurgery for pelvic relapse of gynecologic malignancies. Technol Cancer Res Treat. 2009;8(5):393–400.

    PubMed  Google Scholar 

  39. Flanagan CW, Mannel RS, Walker JL, Johnson GA. Incidence and location of para-aortic lymph node metastases in gynecologic malignancies. J Am Coll Surg. 1995;181(1):72–4.

    CAS  PubMed  Google Scholar 

  40. Chiang AJ, Yu KJ, Chao KC, Teng NN. The incidence of isolated para-aortic nodal metastasis in completely staged endometrial cancer patients. Gynecol Oncol. 2011;121(1):122–5.

    PubMed  Google Scholar 

  41. Sommers GM, Grigsby PW, Perez CA, Camel HM, Kao MS, Galakatos AE, et al. Outcome of recurrent cervical carcinoma following definitive irradiation. Gynecol Oncol. 1989;35(2):150–5.

    CAS  PubMed  Google Scholar 

  42. Grigsby PW, Vest ML, Perez CA. Recurrent carcinoma of the cervix exclusively in the paraaortic nodes following radiation therapy. Int J Radiat Oncol Biol Phys. 1994;28(2):451–5.

    CAS  PubMed  Google Scholar 

  43. Chou HH, Wang CC, Lai CH, Hong JH, Ng KK, Chang TC, et al. Isolated paraaortic lymph node recurrence after definitive irradiation for cervical carcinoma. Int J Radiat Oncol Biol Phys. 2001;51(2):442–8.

    CAS  PubMed  Google Scholar 

  44. Whelan TJ, Dembo AJ, Bush RS, Sturgeon JF, Fine S, Pringle JF, et al. Complications of whole abdominal and pelvic radiotherapy following chemotherapy for advanced ovarian cancer. Int J Radiat Oncol Biol Phys. 1992;22(5):853–8.

    CAS  PubMed  Google Scholar 

  45. Ferrandina G, Legge F, Salutari V, Paglia A, Testa A, Scambia G. Impact of pattern of recurrence on clinical outcome of ovarian cancer patients: clinical considerations. Eur J Cancer. 2006;42(14):2296–302.

    PubMed  Google Scholar 

  46. Brown AP, Jhingran A, Klopp AH, Schmeler KM, Ramirez PT, Eifel PJ. Involved-field radiation therapy for locoregionally recurrent ovarian cancer. Gynecol Oncol. 2013;130(2):300–5.

    PubMed  PubMed Central  Google Scholar 

  47. Albuquerque K, Patel M, Liotta M, Harkenrider M, Guo R, Small W Jr, et al. Long-term benefit of tumor volume-directed involved field radiation therapy in the management of recurrent ovarian cancer. Int J Gynecol Cancer. 2016;26(4):655–60.

    PubMed  Google Scholar 

  48. Chang JS, Kim SW, Kim YJ, Kim JY, Park SY, Kim JH, et al. Involved-field radiation therapy for recurrent ovarian cancer: results of a multi-institutional prospective phase II trial. Gynecol Oncol. 2018;151(1):39–45.

    PubMed  Google Scholar 

  49. Ashworth A, Rodrigues G, Boldt G, Palma D. Is there an oligometastatic state in non-small cell lung cancer? A systematic review of the literature. Lung Cancer. 2013;82(2):197–203.

    PubMed  Google Scholar 

  50. Park HJ, Chang AR, Seo Y, Cho CK, Jang WI, Kim MS, et al. Stereotactic body radiotherapy for recurrent or oligometastatic uterine cervix cancer: a cooperative study of the Korean Radiation Oncology Group (KROG 14-11). Anticancer Res. 2015;35(9):5103–10.

    PubMed  Google Scholar 

  51. Mayer RJ, Berkowitz RS, Griffiths CT. Central nervous system involvement by ovarian carcinoma: a complication of prolonged survivial with metastatic disease. Cancer. 1978;41(2):776–83.

    CAS  PubMed  Google Scholar 

  52. Nasu K, Satoh T, Nishio S, Nagai Y, Ito K, Otsuki T, et al. Clinicopathologic features of brain metastases from gynecologic malignancies: a retrospective study of 139 cases (KCOG-G1001s trial). Gynecol Oncol. 2013;128(2):198–203.

    PubMed  Google Scholar 

  53. Hu XQ, Imitola J, Kim RY, Mahta A, Kesari S. Brain metastasis from ovarian cancer: case report and review of the literature. Med Oncol. 2012;29(2):1250–2.

    PubMed  Google Scholar 

  54. Chang EL, Wefel JS, Hess KR, Allen PK, Lang FF, Kornguth DG, et al. Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol. 2009;10(11):1037–44.

    PubMed  Google Scholar 

  55. Brown PD, Jaeckle K, Ballman KV, Farace E, Cerhan JH, Anderson SK, et al. Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: a randomized clinical trial. JAMA. 2016;316(4):401–9.

    PubMed  PubMed Central  Google Scholar 

  56. Brown PD, Ballman KV, Cerhan JH, Anderson SK, Carrero XW, Whitton AC, et al. Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC.3): a multicentre, randomised, controlled, phase 3 trial. Lancet Oncol. 2017;18(8):1049–60.

    PubMed  PubMed Central  Google Scholar 

  57. Ratner ES, Toy E, O'Malley DM, McAlpine J, Rutherford TJ, Azodi M, et al. Brain metastases in epithelial ovarian and primary peritoneal carcinoma. Int J Gynecol Cancer. 2009;19(5):856–9.

    PubMed  Google Scholar 

  58. Piura E, Piura B. Brain metastases from cervical carcinoma: overview of pertinent literature. Eur J Gynaecol Oncol. 2012;33(6):567–73.

    CAS  PubMed  Google Scholar 

  59. Zindler JD, Rodrigues G, Haasbeek CJ, De Haan PF, Meijer OW, Slotman BJ, et al. The clinical utility of prognostic scoring systems in patients with brain metastases treated with radiosurgery. Radiother Oncol. 2013;106(3):370–4.

    PubMed  Google Scholar 

  60. Walter AC, Gunderson CC, Vesely SK, Algan O, Sughrue M, Slaughter KN, et al. Central nervous system metastasis in gynecologic cancer: symptom management, prognosis and palliative management strategies. Gynecol Oncol. 2015;136(3):472–7.

    PubMed  Google Scholar 

  61. Celejewska A, Tukiendorf A, Miszczyk L, Skladowski K, Wydmanski J, Trela-Janus K. Stereotactic radiotherapy in epithelial ovarian cancer brain metastases patients. J Ovarian Res. 2014;7:79.

    PubMed  PubMed Central  Google Scholar 

  62. Dziggel L, Janssen S, Bajrovic A, Veninga T, Trang NT, Khoa MT, et al. Local therapies can improve intracerebral control in patients with cerebral metastasis from gynecological cancers. Anticancer Res. 2016;36(9):4777–80.

    CAS  PubMed  Google Scholar 

  63. Pakneshan S, Safarpour D, Tavassoli F, Jabbari B. Brain metastasis from ovarian cancer: a systematic review. J Neuro-Oncol. 2014;119(1):1–6.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre, 800 Commissioners Rd East, London, Ontario, N6A 5W9, Canada

    Tina W. Zhang MD, David Palma MD, PhD, David D’Souza MD, Vikram Velker MD & Lucas C. Mendez MD

Authors
  1. Tina W. Zhang MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Palma MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David D’Souza MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vikram Velker MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lucas C. Mendez MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lucas C. Mendez MD.

Ethics declarations

Conflict of Interest

Tina W. Zhang, David Palma, David D’Souza, Vikram Velker, and Lucas C. Mendez declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Gynecologic Cancers

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, T.W., Palma, D., D’Souza, D. et al. Stereotactic Ablative Radiotherapy for Recurrent or Metastatic Gynecological Cancer: Extending Lives?. Curr. Treat. Options in Oncol. 21, 58 (2020). https://doi.org/10.1007/s11864-020-00748-6

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11864-020-00748-6

Keywords

Search

Navigation