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Updated: Jun 24, 2025
Stereotactic Radiosurgery for Gynecologic Cancer
Published on: April 17, 2012
Stereotactic Ablative Radiotherapy for Gynecological Oligometastatic and Oligoprogessive Tumors
Elysia K Donovan1, Simon S Lo2, Sushil Beriwal3
1Department of Oncology, Division of Radiation Oncology, Escarpment Cancer Research Institute, McMaster University, Hamilton, Ontario, Canada.
Importance:
The role of stereotactic ablative radiotherapy (SABR) for gynecologic malignant tumors has yet to be clearly defined despite recent clinical uptake.
Objective:
To evaluate the outcomes of SABR in patients with oligometastatic and oligoprogressive gynecologic cancers.
Design, Setting, And Participants:
In this retrospective pooled analysis, patients with oligometastatic and oligoprogressive gynecologic cancers receiving SABR at 5 institutions from Canada and the US were studied. Data were collected from January 2011 to December 2020, and data were analyzed from January to December 2023.
Exposure:
Stereotactic ablative radiotherapy.
Main Outcomes And Measures:
Cumulative incidence of local and distant recurrence, chemotherapy-free survival (CFS), and overall survival (OS) probabilities after SABR were calculated using Kaplan-Meier methods. Univariable and multivariable analysis was conducted using Cox regression methods.
Results:
A total of 215 patients with 320 lesions meeting criteria were included in the analysis; the median (range) age at primary diagnosis was 59 (23-86) years. The median (range) follow-up from SABR was 18.5 (0.1-124.5) months. The primary site included the endometrium (n = 107), ovary (n = 64), cervix (n = 30), and vulva or vagina (n = 14). Local cumulative incidence of recurrence was 13.7% (95% CI, 9.4-18.9) and 18.5% (95% CI, 13.2-24.5) at 1 and 5 years, respectively. Distant cumulative incidence of recurrence was 48.5% (95% CI, 41.4-55.1) and 73.1% (95% CI, 66.0-79.0) at 1 and 5 years, respectively. OS was 75.7% (95% CI, 69.2-81.1) and 33.1% (95% CI, 25.3-41.1) at 1 and 5 years, respectively. The median CFS was 21.7 months (95% CI, 15.4-29.9). On multivariable analysis, local recurrence was significantly associated with nodal metastasis, lesion size, biologically effective dose, treatment indication, institution, and primary disease type. Distant progression-free survival was associated with nodal targets and lesion size. OS and CFS were significantly associated with lesion size.
Conclusions And Relevance:
In this study, SABR appeared to have excellent local control with minimal toxic effects in this large patient group, and certain patients may achieve durable distant control and OS as well. It may be possible to delay time to chemotherapy in select patient subtypes and therefore reduce associated toxic effects. Prospective multicenter trials will be critical to establish which characteristics procure the greatest benefit from SABR use and to define the ideal time to implement SABR with other oncologic treatments.
Insights
Stereotactic ablative radiotherapy (SABR) shows excellent local control for gynecologic cancers with few side effects. This treatment may help delay chemotherapy, reducing its toxicity in select patients.
Area of Science:
- Gynecologic Oncology
- Radiation Oncology
- Medical Physics
Background:
- The clinical utility of stereotactic ablative radiotherapy (SABR) for gynecologic malignancies remains under investigation.
- Recent clinical adoption necessitates a clearer definition of SABR's role in managing these cancers.
Purpose of the Study:
- To assess the outcomes of SABR in patients with gynecologic cancers presenting with oligometastatic or oligoprogressive disease.
- To evaluate local control, distant recurrence, chemotherapy-free survival (CFS), and overall survival (OS) following SABR.
Main Methods:
- A retrospective pooled analysis of 215 patients with 320 lesions from 5 institutions in Canada and the US.
- Data collected from January 2011 to December 2020, analyzed from January to December 2023.
- Kaplan-Meier methods for survival probabilities and Cox regression for univariable and multivariable analyses.
Main Results:
- Excellent local control was observed, with 1- and 5-year cumulative incidences of local recurrence at 13.7% and 18.5%, respectively.
- Five-year distant recurrence was 73.1%, 5-year OS was 33.1%, and median CFS was 21.7 months.
- Multivariable analysis identified factors like nodal metastasis, lesion size, and biologically effective dose influencing local recurrence, distant progression, OS, and CFS.
Conclusions:
- SABR demonstrates promising local control and minimal toxicity in a large cohort of gynecologic cancer patients.
- Durable distant control and improved OS are achievable in select individuals, potentially allowing for chemotherapy delay.
- Further prospective multicenter trials are essential to identify optimal patient candidates and timing for SABR integration.
