Gynecological Cancer

PV QA 4 - Poster Viewing Q&A 4

TU_18_3500 - Using Stereotactic Body Radiation Therapy (SBRT) in Recurrent, Persistent or Oligometastatic Gynecological Tumors

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Using ­Stereotactic Body Radiation Therapy (SBRT) in Recurrent, Persistent or Oligometastatic Gynecological Tumors
L. B. Reshko1, C. L. Kent1, S. Baliga2, H. Lomas IV3, K. M. Richardson4, K. M. Spencer5, N. R. Bennion6, H. El Ado Mikdachi1, W. P. Irvin1, and C. R. Kersh7; 1Riverside Regional Medical Center, Newport News, VA, 2Montefiore Medical Center, Bronx, NY, 3Enloe Medical Center, Chico, CA, 4MRP, Inc., Milford, OH, 5Riverside Regional Medical Center & University of Virginia Radiosurgery Center, Newport News, VA, 6Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, 7University of Virginia / Riverside Radiosurgery Center, Newport News, VA

Purpose/Objective(s): SBRT is well-tolerated and provides local-regional control in a variety of metastatic and recurrent tumor types. The role of SBRT in extracranial recurrent, persistent, or metastatic gynecological tumors is not well-studied. We therefore compiled a sizeable number of patients to investigate its effectiveness and toxicity in this setting.

Materials/Methods: We performed a retrospective review of 86 patients with 209 tumors treated at our institution between January 2007 and October 2017 with SBRT for recurrent, persistent, or oligometastatic extracranial gynecological tumors including Ovarian (n=86), Endometrial (n=59), Cervical (n=48), Vagina (12), and Vulvar (n=3). 74 tumors were pelvic and 135 were extrapelvic. The median SBRT dose was 38 BED (range 15-113) delivered in a medium of 4 fractions (range 1-6). A non-uniform ITV based on margins constructed from a 4D CT scan was used. IMRT and VMAT planning techniques were considered. Dose was prescribed to a non-uniform ITV based on margins constructed from a 4D CT scan to account for tumor motion. The treatment planning techniques included non-coplanar static aperture ARCs and non-coplanar static fields. IMRT and VMAT planning techniques are considered. Treatments were delivered using a robotic stereotactic radiosurgical approach with a beam modulator. Toxicity was scored using the CTCAE v4.0 system. Radiological imaging and clinical follow up were performed at 3-month intervals or more frequently to assess treatment response. The Kaplan Meier Product Estimator will be used to assess Local Control (LC) and Overall Survival (OS).

Results: The average follow up was 26 months (range 1-91). The indications for SBRT were lymph node metastasis (n=73), recurrent disease (n=51), liver metastasis (n=35), lung metastasis (n=23), persistent disease (n=15), and bone metastasis (n=10). The 1- and 3-year LC were 80% and 68% respectively. The 1- and 3-year OS were 70% and 39%. The average tumor GTV was 32. 32% of the lesions demonstrated complete response, 25% progression of disease, 23% partial response and 20% stable disease. Primary tumor control was achieved in 62% of patients. Toxicity was typically mild with grade 1 gastrointestinal toxicity (GI) and fatigue being the most common (associated with 32 and 18 treatments respectively). Additional toxicities were: four patients with grade 1 skin toxicity, one with grade 1 GU toxicity, three with grade 2 genitourinary (GU) toxicity, three with grade 2 GI toxicity, one with grade 2 fatigue, one with grade 2 nervous system toxicity, one with grade 2 pneumonitis and one with grade 3 GU toxicity.

Conclusion: SBRT offers a high rate of local control with low incidence of toxicity, mainly grade 1 GI toxicity and fatigue, and provides effective salvage therapy for extracranial pelvic and extra-pelvic gynecological tumors.

Author Disclosure: L.B. Reshko: None. C.L. Kent: None. H. Lomas: None. K.M. Richardson: None. K.M. Spencer: None. H. El Ado Mikdachi: None. W.P. Irvin: None.

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