Is Neurosurgery With Adjuvant Radiotherapy an Effective Treatment Modality in Isolated Brain Involvement From Endometrial Cancer?: From Case Report to Analysis

Abstract

Although neuroinvasion from EC appears mostly with a disseminated disease, there is a considerable amount of patients with isolated brain involvement who would have a higher chance of curability. Surgery with radiotherapy is the rational current management option, and this improves the survival for isolated brain involvement from EC.

Brain Metastases from Uterine Cervical and Endometrial Cancer

“…The type of BMs with regard to the presence of extracranial metastases was available for 770 patients [20,28,31,37,49,53,62,63,74,75,84,[117][118][119][120][121][122][123][124][125][126][127][128]131], and extracranial metastases were seen in 346/770 (45.0%) of patients, whereas 424/770 (55.0%) patients had no extracranial metastases. Information on whether the metastasis was a single or multiple BMs was available for 411 patients [28,31,37,49,53,62,63,74,75,87,88,90,[92][93][94][95][96][97][98][99][100][101][102][103]…”

“…Around 2010, a substantial decrease in the number of patients with a single BM was observed (68.0% vs. 42.1%), and this was observed for other solid tumors, as described earlier in the CC section. Data on the site of BMs, that is, whether the metastasis was supratentorial (cerebrum) or infratentorial (cerebellum) or both, were available for 195 patients [20,28,31,49,55,72,75,87,88,90,[92][93][94][95][96][97][98][99][100][101][102][104][105][106][107][108][109][110][112][113][114][117][118][119][120][121][122][124][125][126][127][128]131]. Most of the BMs were located in the supratentorial region (cerebrum; 143/195 (73.3%) patients); in 50/195 (25.6%) and 12/195 (6.2%) patients, the BMs were in the infratentorial region (cerebellum) and in both sites, respectively.…”

“…A literature review conducted in 2016 reported the superiority of surgery followed by WBRT compared to unimodal treatment, based on the median survival of patients with a single BM and no extracerebral involvement (27 months vs. 3.5 months, p < 0.001) [127]. Another review of patients without extracranial lesions revealed that the 2-year survival rate after diagnosis of BMs was 77% in patients who had surgery plus radiotherapy, whereas it was 19% in the surgery alone and 20% in the WBRT alone groups (p = 0.003 and 0.001, respectively) [128]. Recently, as two phase III randomized controlled trials [165,172] showed the noninferiority of surgery plus SRS to surgery plus WBRT for patients with one to four BMs, which are both described in the CC section, future studies regarding the effectiveness of surgery plus SRS for patients with BM from EC are warranted.…”

Combined Open and Endoscopic Endonasal Skull Base Resection of a Rare Endometrial Carcinoma Metastasis

“…Endometrial cancer can rarely present with brain metastasis at initial diagnosis or at recurrence. 1 The vast majority reported are supratentorial lesions. 2 3 4 5 6 Tumors that are treated with surgery and radiotherapy show a significant survival benefit than those treated with surgery or radiotherapy alone.…”

“… 2 3 4 5 6 Tumors that are treated with surgery and radiotherapy show a significant survival benefit than those treated with surgery or radiotherapy alone. 1 7 8 9 10 11 Chemotherapy has not shown to significantly impact intracranial disease. 1 …”