Multimodal therapy improves survival in patients with CNS metastasis from uterine cancer: A retrospective analysis and literature review
Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Division of Gynecologic Oncology, 420 Delaware Street SE, MMC 395, Minneapolis, MN 55455, USA. Gynecologic Oncology
(Impact Factor: 3.77).
11/2007; 107(1):79-85. DOI: 10.1016/j.ygyno.2007.05.027
Brain metastasis from uterine cancer is a rare event. Consequently, the optimal management strategy is not defined. We reviewed our institution's experience with brain metastasis from endometrial cancer along with the extant medical literature to develop management recommendations.
Twenty patients with CNS metastasis were identified. Information regarding symptoms, treatment, and survival was collected. The Kaplan-Meier method was used to compare survival data.
The incidence of CNS metastasis was 0.97%. Median patient age at initial diagnosis of endometrial cancer was 62.0 years and 64.0 years at diagnosis of brain metastasis. Most patients initially presented with advanced FIGO stage: 9 stage IVB, 4 stage IIIC, 4 stage IIIA, 2 stage IB, and 1 stage IA. The median interval from diagnosis of endometrial cancer to diagnosis of brain metastasis was 11.5 months (range 0.6-73.6). Median survival after diagnosis of brain metastasis was 2.0 months (range 0.1-39.2). Improved survival was seen in patients treated with multimodal therapy compared to patients who only received whole brain radiotherapy (WBRT) (p=0.0001) or compared to patients who received no treatment (p=0.009). No difference in survival was seen between patients treated with WBRT versus no therapy. The survival advantage associated with multimodal therapy was also supported by case reports and case series in the literature.
Based upon the data presented along with the medical literature, multimodal therapy appears to improve the survival of patients with CNS metastasis from uterine cancer.
Available from: Shin Nishio
- "The diagnosis of brain metastases has become easier with modern diagnostic modalities; however, 92% of the patients in the present study were symptomatic at the diagnosis of brain metastases. These findings were consistent with a previous report on corpus cancer . It is speculated that, because of its low incidence, brain metastasis was not foreseen by the gynecologic oncologists, and cranial radiographic evaluation was not carried out without evident symptoms. "
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Although brain metastases from gynecologic malignancies are rare, such cases have been gradually increasing in number. The aim of the present study was to evaluate the clinicopathologic features and prognostic factors of brain metastases from gynecologic malignancies.
Retrospective analysis of 139 patients with brain metastases from gynecologic malignancies was carried out as a multi-institutional study. The clinicophathological data of the patients were collected from medical records.
Median survival time of the patients with brain metastases was 12.5 months for the ovarian cancer group, 6.2 months for the corpus cancer group, and 5.0 months for the cervical cancer group; two-year overall survival rates were 19.7%, 6.1%, and 4.8%, respectively. Multivariate analysis revealed ovarian/tubal/peritoneal origin, KPS >70, single brain metastasis, absence of extracranial disease, cranial surgery, cranial radiotherapy, and chemotherapy to be independent favorable prognostic factors associated with overall survival.
It is considered that aggressive multimodal therapy is warranted in the treatment of brain metastases from gynecologic malignancies in carefully selected patients. The present study may provide a platform for the discussion of management strategies in these rare clinical scenarios.
Available from: PubMed Central
- "In 3 patients reported by Orrù et al. , aphasia developed in 2 patients, memory loss: 1, hemiparesis: 1, and headache: 1, and temporary loss of consciousness: 1. In a series of 20 patients with brain metastases from endometrial carcinoma reported by Chura et al. , the most common neurologic symptoms were confusion: 9 (45%) patients, gait disturbance: 8 (40%), paralysis: 4 (20%), speech difficulty: 2 (10%), and nausea and vomiting: 2 (10%). In the singular case reports of brain metastases from endometrial carcinoma published in the literature, common presenting symptoms and signs of brain metastases included headache, confusion, dizziness, decreased mental status, consciousness disturbance, general weakness, extremity weakness, gait disturbance, neurological motor deficit, hemiparesis, ataxia, visual disturbance, papilledema, incontinence, nausea, vomiting, speech impairment (aphasis), parasthesias, syncope, and seizure. "
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ABSTRACT: This paper will focus on knowledge related to brain metastases from endometrial carcinoma. To date, 115 cases were documented in the literature with an incidence of 0.6% among endometrial carcinoma patients. The endometrial carcinoma was usually an advanced-stage and high-grade tumor. In most patients (~90%), brain metastasis was detected after diagnosis of endometrial carcinoma with a median interval from diagnosis of endometrial carcinoma to diagnosis of brain metastases of 17 months. Brain metastasis from endometrial carcinoma was either an isolated disease limited to the brain only (~50%) or part of a disseminated disease involving also other parts of the body (~50%). Most often, brain metastasis from endometrial carcinoma affected the cerebrum (~75%) and was solitary (~60%). The median survival after diagnosis of brain metastases from endometrial carcinoma was 5 months; however, a significantly better survival was achieved with multimodal therapy including surgical resection or stereotactic radiosurgery followed by whole brain radiotherapy (WBRT) and/or chemotherapy compared to WBRT alone. It is suggested that brain imaging studies should be considered in the routine follow up of patients with endometrial carcinoma and that the search for a primary source in females with brain metastases of unknown primary should include endometrial biopsy.
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ABSTRACT: Leptomeningeal carcinomatosis is a rare metastatic event in gynecological neoplasias, and most cases occur in ovarian cancer. It is extremely infrequent in cervical cancer, and so far, there are not any reports of this complication in association with endometrial cancer.
We report a case of leptomeningeal carcinomatosis secondary to endometrial carcinoma and 2 complex cervix cancer cases. A MEDLINE search was done to review all published cases of this complication in gynecological cancer to identify predictive factors for this diagnosis.
Leptomeningeal carcinomatosis is usually diagnosed late in the course of the disease, and most reports concern ovarian cancer patients. The number of cases describing this neurologic complication in cervix cancer is increasing. Gadolinium-enhanced magnetic resonance imaging may be necessary for this diagnosis, because cerebrospinal fluid analysis results may be negative. Most cervix cases had squamous cell (8/14) or neuroendocrine histologic subtype (3/14), and when reported, differentiation was usually poor. The case we report of endometrial carcinoma, unique in the literature, is a serous adenocarcinoma.
A high index of suspicion is necessary, and leptomeningeal carcinomatosis should be considered in patients with unexplained neurologic symptoms whose gynecologic tumors are poorly undifferentiated or have a serous component.
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