Introduction: Gynecologic malignancies represent some of the commonest causes of cancer in the female population. Despite their overall high prevalence, gynecologic malignancies have seldom been reported to metastasize to the brain. The incidence of gynecologic cancers spreading to the brain has been rising, and the optimal management of these patients is not well defined. Gamma Knife radiosurgery (GKRS) has been shown to be an effective treatment option for metastatic tumors from lung and breast cancer. In this study, the efficacy and safety of GKRS for metastatic gynecologic tumors is evaluated.

Methods: A retrospective analysis of patients treated over the past 10 years with GKRS for metastatic gynecologic cancer to the brain was performed. Radiographic treatment response, tumor control, metastatic disease progression and survival data were analyzed.

Results: Eight patients with ovarian cancer, six patients with endometrial cancer and two separates who carried a diagnosis of cervical cancer or leiomyosarcoma harbored metastatic disease to the brain that was treated with GKRS. The median dose to the tumor margin was 20Gy and the median maximum radiosurgical dose was 31Gy. Tumor control was achieved in all patients who had follow up imaging studies. Patients with ovarian cancer had a significantly longer median survival following GKRS compared to patients with endometrial cancer (22.3 months versus 8.3 months, p = 0.02). Patients who had prolonged survival following GKRS with ovarian cancer tended to have stable primary disease. The patient with cervical cancer survived 8 months following GKRS, whereas the patient with leiomyosarcoma passed away within several weeks of treatment secondary to disseminated extracranial disease.

Conclusions: GKRS is an effective treatment option for patients with gynecologic cancer that has spread to the brain. Patients with metastatic ovarian cancer appear to have prolonged survival following GKRS.

Patient Care: This work provides important data on the treatment of metastatic brain tumors that rarely spread to the brain. Thus, although retrospective in nature, this work adds to the very limited body of knowledge with regards to the optimal treatment of patients with gynecologic tumors that have metastasized to the central nervous system. Of the data that does exist, some authors have suggested that surgery followed by whole brain radiotherapy (WBRT) may provide survival benefit for these patients. The data reported herein suggests that stereotactic radiosurgery may be a suitable alternative to open surgery and WBRT. In this way, who may not be ideal candidates for open surgery likely will benefit from less invasive stereotactic radiosurgery.

Learning Objectives: 1) Describe the incidence of primary gynecologic malignancies and the rate at which they metastasize to the brain. 2) Suggest treatment strategies for patients who harbor metastatic gynecologic malignancies to the brain. 3)Discuss possible mechanisms why patients with ovarian cancer treated with GKRS have markedly improved outcomes compared to their endometrial cancer counterparts despite adequate metastatic tumor control being achieved in both groups

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