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Background: The use of stereotactic radiotherapy (SBRT) for oligometastases is supported by several studies, despite being quite unexplored in the setting of gynecological malignancies. This study reports a preliminary evaluation of clinical outcomes in a cohort of 40 patients with oligometastatic gynecological cancers.

Methods: Radiotherapy was delivered in 3-10 fractions with VMAT-IGRT technique. Toxicity was retrospectively collected according to CTCAE v4.0. Univariate and multivariate analyses were performed for assessing any potential predictive factor for clinical outcomes.

Results: A total of 63 oligometastases were treated from December 2014 to February 2021. Median age was 63 years (range 30-89). Most frequent primary tumors were ovarian cancer in 42.5% and endometrium cancer in 42.5%. With a median follow-up of 27 months (range 6-69), no local failures were observed, our progression-free survival rates were 43.6% and 23% at one and 2 years, respectively. Sixteen patients developed a sequential oligometastatic disease, candidate to a further SBRT course, with a second progression-free survival (PFS2) of 13 months (range 2–27); nonetheless,  this did not lead to a survival advantage, when compared to patients who developed immediate polymetastatic spread (p= 0.47). 1 and 2-year overall survival rates were both 70%, with only one patient dead by disease. No acute or late G≥ 2 adverse events were observed.

Conclusions: SBRT for oligometastatic gynecological malignancies resulted in promising results in terms of clinical outcomes, with excellent local control and no evidence of severe toxicity. Prospective studies to further investigate the role of this option in the management of gynecological malignancies are advocated.