Primary brain metastases of endometrial cancer: A report of 18 cases and review of the literature

Objective: To present a series of brain metastases from endometrial cancer (EC) and describe a comprehensive review of the literature. Methods: We retrospectively reviewed medical records of 1) patients with cerebral dissemination of EC treated at Mayo Clinic from 1984 to 2001 and 2) all patients referred for treatment of primary brain metastases after primary treatment for EC elsewhere. We also reviewed published case reports and case series describing cerebral spread of EC. Results: Among the 1632 patients treated at Mayo, 14 (0.86%) had primary brain dissemination; 4 additional referral cases were identified (total, 18 patients). In 2 cases (11.1%), diagnosis of brain metastases was made at presentation of EC; in the others, median time to development of brain metastasis was 5 (range, 1-57) months. Median survival was 57 (range, 7-118) months in patients with single cerebral metastases and no extracerebral involvement (n = 6); for the remaining 12 patients, median survival was 4 (range, 0-28) months. Among the 6 patients with single brain metastases, complete surgical excision was possible in 5; in that group, the overall survival was 64 (range, 12-118) months. We identified 98 cases of brain metastases of EC in the literature: 58 were primary cerebral metastases. Overall survival after brain dissemination was significantly higher in patients with a single metastasis without other localization and receiving multimodal treatment including surgery and whole-brain radiotherapy. Conclusions: Single primary brain metastases without extracerebral spread seem to have a relatively favorable prognosis. Aggressive multimodal treatment may include surgery and brain radiation.