3D Conformal Radiotherapy in Cervical Metastasis to Brain

Background. Cervical cancer is among the commonest malignancies and a top fourth leading cause of cancer death in women worldwide. The five-year survival rate in locally advanced cervical cancer is 91.5%, and only 17.2% — in distant metastasis. Primary cervical cancer metastasis to brain is very rare. Report and analysis of quite rare clinical cases may shed light on this issue, helping formulate relevant therapeutic and diagnostic interventions.

Materials and methods. The article describes a case of cervical cancer metastasis to brain. The patient received modern 3D conformal intensity-modulated (IMRT) and image-guided (IGRT) radiation therapies on an Elekta Synergy highenergy linear digital accelerator instrument.

Results. Clinical effect has been achieved by end of treatment. Time since diagnosis of primary cervical cancer was 13 months, and 7 months — since diagnosis of brain metastasis.

Discussion. The survival rate in brain metastasis is marginal-low and depends on the patient’s age, primary tumour state, presence of extracranial metastases, as well as volume, number and location of metastases in brain parenchyma. An integrated approach including surgery, radiation and chemotherapy is considered superior to improve survival and the quality of life.

Conclusion. Despite sheer coverage of therapies available, the mean survival rate in intracranial metastasis remains subtle. Thereby, research and discovery of relapse and metastasis biomarkers of cervical cancer is relevant. 

1. Bray F., Ferlay J., Soerjomataram I., Siegel R.L., Torre L.A., Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. DOI: 10.3322/caac.21492

2. Howlader N., Krapcho M., Miller D., Brest A., Yu M., Ruhl J., et al. SEER Cancer Statistics Review, 1975–2017. Bethesda: National Cancer Institute; 2020.

3. Global strategy to accelerate the elimination of cervical cancer as a public health problem. WHO; 2020. 4 Surveillance, epidemiology end results program. Cancer Stat Facts: Cervical Cancer; National Cancer Institute. [cited 2020 Dec 20]. Available online: https://seer.cancer.gov/statfacts/html/cervix.html

4. Li H., Wu X., Cheng X. Advances in diagnosis and treatment of metastatic cervical cancer. J Gynecol Oncol. 2016;27(4):e43. DOI: 10.3802/jgo.2016.27.e43

5. Divine L.M., Kizer N.T., Hagemann A.R., Pittman M.E., Chen L., Powell M.A., et al. Clinicopathologic characteristics and survival of patients with gynecologic malignancies metastatic to the brain. Gynecol Oncol. 2016;142(1):76–82. DOI: 10.1016/j.ygyno.2016.04.030

6. Fetcko K., Gondim D.D., Bonnin J.M., Dey M. Cervical cancer metastasis to the brain: a case report and review of literature. Surg Neurol Int. 2017;8:181. DOI: 10.4103/sni.sni_111_17

7. Zhang T.W., Palma D., D’Souza D., Velker V., Mendez L.C. Stereotactic ablative radiotherapy for recurrent or metastatic gynecological cancer: extending lives? Curr Treat Options Oncol. 2020;21(7):58. DOI: 10.1007/s11864-020-00748-6

8. Walter A.C., Gunderson C.C., Vesely S.K., Algan O., Sughrue M., Slaughter K.N., et al. Central nervous system metastasis in gynecologic cancer: symptom management, prognosis and palliative management strategies. Gynecol Oncol. 2015;136(3):472–7. DOI: 10.1016/j.ygyno.2014.12.020

9. Kim H., Lee K.K., Heo M.H., Kim J.Y. The prognostic factors influencing overall survival in uterine cervical cancer with brain metastasis. Korean J Intern Med. 2019;34(6):1324–32. DOI: 10.3904/kjim.2018.051

10. Hayashi N., Takahashi H., Hasegawa Y., Higuchi F., Takahashi M., Makino K., et al. A nationwide multi-institutional retrospective study to identify prognostic factors and develop a graded prognostic assessment system for patients with brain metastases from uterine corpus and cervical cancer. BMC Cancer. 2017;17(1):397. DOI: 10.1186/s12885-017-3358-6

11. Nasioudis D., Persaud A., Taunk N.K., Latif N.A. Brain metastases from gynecologic malignancies: prevalence and management. Am J Clin Oncol. 2020;43(6):418–21. DOI: 10.1097/COC.0000000000000689

12. Zhang Y., Grant M.S., Stepp W.H., Clark L.H. Clinical characteristics of CNS metastases from primary gynecologic cancers. Gynecol Oncol Rep. 2019;30:100518. DOI: 10.1016/j.gore.2019.100518

13. Sadik Z.H.A., Beerepoot L.V., Hanssens P.E.J. Efficacy of gamma knife radiosurgery in brain metastases of primary gynecological tumors. J Neurooncol. 2019;142(2):283–90. DOI: 10.1007/s11060-019-03094-2

14. Bi Y., Li L. Pathologically confirmed brain metastases from primary uterine cervical tumors: Two cases and a literature review. World J. Surg. Oncol. 2019;(17):1–8. DOI:10.1186/s12957-019-1720-7