Brain Metastases from Uterine Cervical and Endometrial Cancer.

Mayumi Kobayashi Kato,Yasuhito Tanase,Mitsuya Ishikawa,Masaya Uno,Tomoyasu Kato

doi:10.3390/cancers13030519

Abstract

Simple SummaryThis review investigated the prevalence, clinical characteristics, clinical presentation, diagnosis, treatment, and prognosis of patients with brain metastases from uterine cervical carcinoma (CC) and uterine endometrial carcinoma (EC). The findings of this review indicate the factors that can facilitate better treatment selection and, consequently, better outcomes in patients with CC and EC.Reports on brain metastases (BMs) from uterine cervical carcinoma (CC) and uterine endometrial carcinoma (EC) have recently increased due to the development of massive databases and improvements in diagnostic procedures. This review separately investigates the prevalence, clinical characteristics, clinical presentation, diagnosis, treatment, and prognosis of BMs from CC and uterine endometrial carcinoma EC. For patients with CC, early-stage disease and poorly differentiated carcinoma lead to BMs, and elderly age, poor performance status, and multiple BMs are listed as poor prognostic factors. Advanced-stage disease and high-grade carcinoma are high-risk factors for BMs from EC, and multiple metastases and extracranial metastases, or unimodal therapies, are possibly factors indicating poor prognosis. There is no “most effective” therapy that has gained consensus for the treatment of BMs. Treatment decisions are based on clinical status, number of the metastases, tumor size, and metastases at distant organs. Surgical resection followed by adjuvant radiotherapy appears to be the best treatment approach to date. Stereotactic ablative radiation therapy has been increasingly associated with good outcomes in preserving cognitive functions. Despite treatment, patients died within 1 year after the BM diagnosis. BMs from uterine cancer remain quite rare, and the current evidence is limited; thus, further studies are needed.

Highlights

Malignancies arising from the uterus can be divided into two groups: uterine cervical carcinoma (CC) and uterine endometrial carcinoma (EC)
The surveillance, epidemiology, and end results program (SEER) database undertook a search of metastasis information related to the liver, lung, bone, and brain since 2010, and found that the reported numbers of brain metastases (BMs) from CC and EC have been increasing, and more than 85% of all cases were reported after 2010 in both CC and EC
The surveillance, epidemiology, and end results program (SEER) database undertook a search of metastasis information related to the liver, lung, bone, and brain from 2010 onwards, and found that the reported numbers of BMs from CC and EC have been increasing, and more than 85% of all cases were reported after 2010 in both CC and EC

Summary

Introduction

Malignancies arising from the uterus can be divided into two groups: uterine cervical carcinoma (CC) and uterine endometrial carcinoma (EC). The 5-year survival rate for patients with distant metastatic CC is only 17.2%, compared to 91.5% for those with localized CC [3]. The rate of incidence of EC shows a significant upward trend relative to a declining birthrate and growing epidemic of obesity, especially in developed countries, with an estimated 382,000 new cases and 89,900 deaths reported worldwide in 2018 [2]. When metastases do occur in EC, the treatment options are severely limited, and the 5-year survival rate of 16.3% for patients with distant metastases indicates an unfavorable prognosis [4]. CC metastasizes to para-aortic lymph nodes and supraclavicular lymph nodes more frequently than EC [5] Both of these cancers can spread hematogenously to distant organs, such as the lung, liver and bone. The previous studies showed that the frequency of metastases to these distant organs from CC is higher than that of metastases from EC [5,6]

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