Endometrial carcinoma is a rare cause of brain metastases, accounting for less than 1% of all metastatic lesions to the brain. This report aims to review our experience in the treatment of patients with brain metastases from endometrial carcinoma in order to establish the characteristics of these patients and evaluate the results and efficacy of whole-brain radiation therapy as a palliative measure.
Methods
Three cases of brain metastases from endometrial carcinoma treated with radiotherapy were identified in the files of the Division of Radiotherapy at the A. Businco Regional Oncological Hospital of Cagliari between 1999 and 2005.
Results
All patients had brain metastases as the only sign of systemic disease (a single lesion in 2 patients and 2 lesions in 1 patient). Two patients were classified as RTOG RPA class I and 1 patient as class III. Radiotherapy to the brain was delivered after surgical resection in the first 2 patients and as the only method of palliation in the third patient. The delivered radiation dose was 3000 cGy in 10 fractions over 2 weeks in the postoperative setting and 2000 cGy in 5 fractions over 1 week to the patient treated with irradiation alone. The 2 surgically treated patients are alive and well after 16 and 64 months, respectively. The patient treated with palliative intent died 2 months after irradiation.
Conclusions
The combination of surgery and postoperative whole-brain irradiation in selected patients with solitary brain metastases from endometrial carcinoma is an effective method of palliation.
PosnerJ.B.: Management of brain metastases.Rev Neurol.148: 477–487, 1992.
2.
TaillibertS.DelattreJ.Y.: Palliative care in patients with brain metastases.Curr Opin Oncol.17: 588–592, 2005.
3.
ZimmS.WamplerG.S.StableinD.HazraT.YoungH.F.: Intracerebral metastases in solid-tumor patients: natural history and results of treatment.Cancer.48: 384–394, 1981.
4.
GrafA.H.BuchbergerW.LangmayrH.SchmidK.W.: Site preference of metastatic tumours of the brain.Virchows Arch A Pathol Anat Histopathol, 412: 493–498, 1988.
5.
ParkinD.M.BrayF.FerlayJ.PisaniP.: Global cancer statistics, 2002.CA Cancer J Clin, 55: 74–108, 2005.
6.
MarianiA.WebbM.J.KeeneyG.L.CaloriG.PodratzK.C.: Hematogenous dissemination in corpus cancer.Gynecol Oncol, 80: 233–238, 2001.
7.
Le ChevalierT.SmithF.P.CailleP.ConstantsJ.P.RouesseJ.G.: Sites of primary malignancies in patients presenting with cerebral metastases.Cancer, 56: 880–882, 1985.
8.
AaldersJ.G.AbelerV.KolstadP.: Stage IV endometrial carcinoma: a clinical and histopathological study of 83 patients.Gynecol Oncol, 17: 75–84, 1984.
9.
Kottke-MarchantK.EstesM.L.NunezC.: Early brain metastases in endometrial carcinoma.Gynecol Oncol, 41: 67–73, 1991.
10.
RuelleA.ZuccarelloM.AndrioloG.: Brain metatasis from endometrial carcinoma. Report of two cases.Neurosurg Rev, 17: 83–87, 1994.
11.
De WitteO.LefrancF.SalmonI.ViolonP.BrotchiJ.: Metastases cerebrales d'origine gynecologique.Neurochirurgie, 42: 216–220, 1996.
12.
Mahmoud-AhmedA.S.SuhJ.H.BarnettG.H.WebsterK.D.BelinsonJ.M.KennedyA.W.: The effect of radiation therapy on brain metastases from endometrial carcinoma: a retrospective study.Gynecol Oncol, 83: 305–309, 2001.
13.
PetruE.LaxS.KurshelS.GucerF.SetterB.: Long-term survival in a patient with brain metastasis preceding the diagnosis of endometrial cancer.J Neurosurg, 94: 846–848, 2001.
14.
ShioharaS.OharaM.ShiozawaT.KonishiI.: Successful treatment with stereotactic radiosurgery for brain metastases of endometrial carcinoma: a case report and review of the literature.Int J Gynecol Cancer, 13: 71–76, 2003.
15.
GienL.T.KwonJ.S.D'SouzaD.P.RadwanJ.S.HammondJ.A.SugimotoA.K.CareyM.S.: Brain metatases from endometrial carcinoma: a retrospective study.Gynecol Oncol, 93: 524–528, 2004.
16.
SalibiB.S.BeltaosE.: Endometrial adenocarcinoma with cerebral metastasis and subdural ossification.Wis Med J.71: 255–258, 1973.
17.
NakanoK.K.SchoeneW.C.: Endometrial carcinoma with predominant clear-cell pattern with metastases to the adrenal. posterior mediastinum and brain.Am J Obstet Gynecol, 122: 529–530, 1975.
18.
TurnerD.M.GrafC.J.: Nontraumatic subdural hematoma secondary to dural metastasis: case report and review of the literature.Neurosurg.11: 678–680, 1982.
19.
RitchieW.W.MessmerJ.M.WithleyD.P.GolperudD.R.: Uterine carcinoma metastatic to the larynx.Laryngoscope.95: 97–98, 1985.
20.
BrezinkaC.FendF.HuterO.PlattnerA.: Cerebral metastasis of endometrial carcinoma.Gynecol Oncol, 38: 278–281, 1990.
21.
SawadaM.InagakiM.OzakiM.YamasakiM.NakagawaH.InoueT.TeradaN.WadaA.: Long-term survival after brain metastasis from endometrial cancer.Jpn J Clin Oncol.20: 312–315, 1990.
22.
De PorreP.M.Subandono TjokrowardojoA.J.: Brain metatases of endometrial carcinoma. Case report and review of the literature.Strahlenther Onkol, 168: 100–101, 1992.
23.
WronskiM.ZakowskiM.ArbitE.HoskinsW.J.GalichichJ.H.: Endometrial cancer metastasis to the brain: report of 2 cases and a review of the literature.Surg Neurol, 39: 355–359, 1993.
24.
CormioG.LissoniA.LosaG.ZanettaG.PellegrinoA.MangioniC.: Brain metatases from endometrial carcinoma.Gynecol Oncol, 61: 40–43, 1996.
25.
Martinez-ManasR.M.BrellM.RumiaJ.FerrerE.: Brain metatasis in endometrial carcinoma.Gynecol Oncol, 70: 282–284, 1998.
26.
SalvatiM.CervoniL.RagusoM.: Therapeutic considerations in solitary cerebral metastases from uterine carcinoma.Minerva Ginecol, 50: 445–447, 1998.
27.
OgawaK.ToitaT.KakinohanaY.KamataM.MoromizatoH.NagaiY.HigashiM.KanazawaK.YoshiiY.: Palliative radiation therapy for brain metatases from endometrial carcinoma: report of two cases.Jpn J Clin Oncol.29: 498–503, 1999.
28.
CrispinoM.TiraA.VolpiD.OlivettiL.: Solitary brain metastasis from endometrial carcinoma. A case report.Radiol Med, 100: 515–517, 2000.
29.
SewakS.MuggiaF.M.ZagzagD.: Endometrial carcinoma with cerebellar metastasis. A case report and review of the literature.J Neurooncol, 58: 137–140, 2002.
30.
ElliotK.S.BorowskyM.E.LeeY.C.RaoC.AbulafiaO.: Prolonged survival in recurrent endometrial carcinoma to the brain.Gynecol Oncol, 95: 247–251, 2004.
31.
GasparL.ScottC.RotmanM.AsbellS.PhillipsT.WassermanT.McKennaW.G.ByhardtR.: Recursive partitioning analysis (RPA) of prognostic factors in 3 Radiation Therapy Oncology Group (RTOG) brain metastases trials.Int J Radiat Oncol Biol Phys, 37: 745–751, 1997.
32.
DelattreJ.Y.KrolG.ThalerH.T.PosnerJ.B.: Distribution of brain metastases.Arch Neurol, 45: 741–744, 1988.
33.
El KamarF.G.PosnerJ.B.: Brain metastases.Semin Neurol, 24: 347–362, 2004.
34.
BerkL.: An overview of radiotherapy trials for the treatment of brain metastases.Oncology, 9: 1205–1219, 1995.
35.
KhuntiaD.BrownP.LiJ.MehtaM.P.: Whole-brain radiotherapy in the management of brain metastasis.J Clin Oncol, 24: 1295–1304, 2006.
36.
HoeglerD.: Radiotherapy for palliation of symptoms in incurable cancer.Curr Probl Cancer, 21: 129–183, 1997.
37.
LutterbachJ.BarteltS.OstertagC.: Long-term survival in patients with brain metastases.J Cancer Res Clin Oncol, 128: 417–425, 2002.
38.
BorgeltB.GelberR.KramerS.ChangC.H.DavisL.W.PerezC.A.HendriksonF.R.: The palliation of brain metastases: final results of the first two studies by the Radiation Therapy Oncology Group.Int J Radiat Oncol Biol Phys, 6: 1–9, 1980.
39.
KurtzJ.M.GelberR.BradyL.W.CarellaR.J.CooperJ.S.: The palliation of brain metastases in a favourable patient population. A randomized clinical trial.Int J Radiat Oncol Biol Phys, 7: 891–895, 1981.
40.
BradleyK.A.MehtaM.P.: Management of brain metastases.Semin Oncol, 31: 693–701, 2004.
41.
PatchellR.A.: The management of brain metastases.Cancer Treat Rev, 29: 533–540, 2003.
42.
BajajG.K.KleinbergL.TerezakisS.: Current concepts and controversies in the treatment of parenchymal brain metastases: improved outcomes with aggressive management.Cancer Invest, 23: 363–376, 2005.
NoordijkE.M.VechtC.J.Haaxma-ReicheH.PadbergG.W.VoormolenJ.H.HoekstraF.H.TansJ.T.LambooijN.MetsaarsJ.A.WattendorffA.R.: The choice of treatment of single brain metastasis should be based on extracranial tumor activity and age.Int J Radiat Oncol Biol Phys, 29: 711–717, 1994.
45.
MintzA.H.KestleJ.RathboneM.P.GasparL.HugenholtzH.FisherB.DuncanG.SkingleyP.FosterG.LevineM.: A randomized trial to assess the efficacy of surgery in addition to radiotherapy in patients with a single cerebral metastasis.Cancer, 78: 1470–1476, 1996.
46.
PatchellR.A.TibbsP.A.WalshJ.W.DempseyR.J.MaruyamaY.KriscyoR.J.MarkesberyW.R.McDonaldJ.S.YoungB.: A randomized trial of surgery in the treatment of single metastases to the brain.N Engl J Med, 322: 494–500, 1990.
47.
PatchellR.A.TibbsP.A.RegineW.F.DempseyR.J.MohiuddinM.KryscioR.J.MarkesberyW.R.FoonK.A.YoungB.: Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial.JAMA, 280: 1485–1489, 1998.
48.
HazardL.J.JensenR.L.ShrieveD.C.: Role of stereotactic radiosurgery in the treatment of brain metastases.Am J Clin Oncol, 28: 403–410, 2005.
AlexanderEIIIMoriartyT.M.LoefflerI.S.: Radiosurgery for metastases.J Neurooncol, 27: 279–285, 1996.
51.
YoungR.F.: Radiosurgery for the treatment of brain metastases.Semin Surg Oncol, 14: 70–78, 1998.
52.
KondziolkaD.MartinJ.J.FlickingerJ.C.FriedlandD.M.BrufskyA.M.BaarJ.AgarwalaS.KirkwoodJ.M.LunsfordL.D.: Long-term survivors after gamma knife radiosurgery for brain metastases.Cancer, 104: 2784–2791, 2005.
53.
MehtaM.P.TsaoM.N.WhelanT.J.MorrisD.E.HaymanJ.A.FlickingerJ.C.MillsM.RogersC.L.SouhamiL.: The American Society for Therapeutic Radiology and Oncology (ASTRO) evidence-based review of the role of radiosurgery for brain metastases.Int J Radiat Oncol Biol Phys, 63: 37–46, 2005.
54.
StafinskiT.JhangriG.S.YanE.MenonD.: Effectiveness of stereotactic radiosurgery alone or in combination with whole brain radiotherapy compared to conventional surgery and/or whole brain radiotherapy for the treatment of one or more brain metastases: A systematic review and meta-analysis.Cancer Treat Rev, 32: 203–213, 2006.
